820284_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

Type of Visit: eTompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: G' Ioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p p Arrival Time: ' Departure Time: County: Region:
Farm Name: 47e.i Owner Email:
Owner Name: �-� 7L Phone:
Mailing Address:
Physical Address:
Facility Contact: (:' Ne4 of VJ z•-41 - }Title: tq W h V_- f/,- Phone:
Onsite Representative: I1 h p �t�t W �f,'1-. Integrator:
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Non -Layer
Design
Gapaeity
Current Design Current
Pop. Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
We to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
D . Pout_
Design
Ca aci
Current Dry Cow
P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Turke Poults
Beef Feeder
Beef Brood Cow
Boars
Other
Other JEJ 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes El -No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
ion
❑ NA
❑ NE
❑ Yes
Q'No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facifi Number: Date of inspection: O� o
lWaste Collection & Treatment
r. 4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): {
Observed Freeboard (in): j sr
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes J5-9.' ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 46 were answered yes, and the situation poses an immediate public health or enviro mental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 3-No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0-'No ❑ NA ❑ NE
maintenance or improvement?
Waste ApOication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/ Window L ❑ Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s): 0� rv%- I G 7�' �S -�_ e , / GU i /T _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[—]Yes
E No
❑ NA
❑ NE
❑ Yes
❑-lq-o
❑ NA
❑ NE
❑ Yes
[
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
[—]Yes
[D No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ WE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:)Yes
[P "'o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'ice o
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [3No ❑ NA ❑ NE
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes to ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M-N-*o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ETNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
6-N/o ❑ NA ❑ NE
Comments (refer to gees on #)::Explain any YES answers -.and/or any�additional recommendations ai any other�comments:
Use drawings of factlity.to, better explain situations (use ad...dttsonalpages as necessary). ..,,, ...
d'ra-5 aia--�- �
t�
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: 3y-Ol SS/
Date:
21412015

-- ow —14
(Type of Visit: (Q'Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: J7k<outine O Complaint O Follow-up p Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; p c7 Departure Time: 'OD County: fh- Region: T�
Farm Name: {�GL/ 1?[s Owner Email:
Owner Name: —Lyl_ -,- (,{j �.�� Phone:
Mailing Address:
Physical Address:
Facility Contact: _�' el! -r— wz-:�S Title: ,(� W17 Phone:
v
Onsite Representative: ���riv-- Integrator:/ZJ2�7�
Certified Operator: �/_
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude: Longitude:
Im
Swine
Design Current
MR.
Wet Poury
Design
@ pacify
Current
Pop.
Desill gn Current
Cattle Capacity Pop..
Wean to Finish
La er
Daia Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
G
-
k Design .Current
Dr. 1?oult . :. Ga aei Po P.
Dairy 1leifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -I a ers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
°
Other
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ly— ❑NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes LNo
❑ Yes J2]-NO
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: ate of Inspection: — /S—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eallo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 1
Observed Freeboard (in):� 5—y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [K No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
2[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LEI —No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): �L
13. Soil TYpe(s): e��-0'4 Z'Aj .7f —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eallo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes & N
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (. No [_]NA [_]NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes CRNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ja No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E,No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1:2 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[&No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[.No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EAfo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: /Q— Deli 07
Date:
21412015

f -- .1�w z -s-lc
ivis"ioon bf Water Resources
Facility Number ®- Division of Soil and Water Conservation
© Other Agency
Type of Visit: omp6ance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /� p� / Arrival Time: ; 00 Departure Time: . D -, County:, Region: F-7/Z
Farm Name: Owner Email:
Owner Name: ��z-� ,r _j rr Phone:
Mailing Address:
Physical Address:
Facility Contact: t'r-r Y Uje__S If- Title: e0GUo-1 �c✓ Phone:
Onsite Representative: 71g'�
Certified Operator: _.:�5 A'�_
Back-up Operator:
Location of Farm:
Latitude:
Integrator: /'r-13
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
apacity C
Pop.
Cattle Capacity Pop.
Wean to Finish
r
EEELayer
DairyCow
Wean to Feeder
Dairy Calf
]Dairy Heifer
Feeder to Finish
Farrow to Wean
gn
PZi
Current
D Cow
Farrow to Feeder
Dr. P,onl
a i
Po -
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:35
Qther
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
r] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes g) No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

' Facility Number: - Date of Inspection: —
p -/b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[X[No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C54 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
6Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []jLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
L
12. Crop Type(s): c/rA_ ZC`"-- f,U--,• r•r
13. Soil Type(s): 14
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fallo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ZI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes EINo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists 0 Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .o No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�j No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

iFacility Number. Date of Inspection: (p r-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C&No ❑ NA ❑ NE
y
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tallo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ER No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Co No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[&No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: -- 3Z) --;70/6
21412015
Page 3 of 3

h
l✓ -7 -,;?o1S- sfih v
Type of Visit: ®'Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: / Arrival Time: ` r7 Departure Time: p ; D� County: Sc sfi=— Region: 17--X V
Farm Name:Owner Email:
Owner Name: yr e-'t Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: rj/tJ`iYr Phone:
Onsite Representative: ��`�� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Desiga Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Capacity Pop.
Wean to Finish La er Da'Dairy Cow
Wean to Feeder Non -Layer Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean n Dry Cow
Farrow to Feeder D . P,oul Ca -aci Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other, ey Poults
11
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
®No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
C] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 91
y--
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r'ZX No
❑ NA
❑ Nl;
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0 r ►ti f !y t An,
13. Soil Type(s):.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes UK No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EKNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. Ryes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [—]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall []Stocking ❑Crop Yield �120 Minute Inspections _]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ['Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes S No
❑ Yes VVNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Contments'(refer to question #): Explain any YES answers and/or any additional recomm- endations or any other comments
Use.drawings of facility to better explain situations (use additional pages as necessary).
1,9"), X "�d wrap c00% C�— /'�?o V"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �2'2LI
Date: t j�
21412011

Type of Visit: Q'Compl' nce Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: C5 Routine O Complaint O Follow-un O Referral O Emergencv O Other O Denied Access
Date of Visit: Arrival Time: ; D Departure Time: J Q ; County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: evI Title: Phone:
Region: �-U
Onsite Representative:_ Integrator:
Certified Operator: .5.w� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- Desigti�Curreut Destgn grrent
CaP ctty Pop.' Wet Poultry C�apact yaPop.
Finish La er
rUWeaEntoFeeder Non -La er
Design Current
Cattle Capacity Pop.
Dai Cow
Da' Calf
airy Heifer
D Cow
o Finish
Farrow to Wean
�.
—A
ffsignCurrent
D . P,oul Ca acttyPo .
Layers
Farrow to Feeder
Non -Da'
Beef Stocker
Farrow to Finish
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
a
Other
Other
-
Turkeys
Turke Pouets
Other
..........
Discharges and Stream Imuacts
I . Is any discharge observed from any part of the operation? ❑ Yes jNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
[:]Yes �jNo
[:]Yes [5-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

.LFaqft Number: - Date of Ins ection:
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): -- ZZ
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
®.No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[-]Yes OR�No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�LNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
L& No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ NA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DANo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;FLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e® "I'L- �GU� �- i7il= / eal? . "�
13. Soil Type(s): p,1f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Fe ,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
D Yes allo ❑ NA ❑ NE
❑ Yes ZLNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P4 No NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fKNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 29-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CRNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Pj No
❑ NA
❑ NE
❑ Yes ® No [DNA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
[:]Yes ®.No ❑ NA ❑ NE
❑ Yes rM No
❑ Yes � No
❑ Yes JQ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
iComments.(refer to question #I): Explain any YES answers and/or any additional recommendations or anyother comments:::_
tise'drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: r AV
21412011

DIWk5
-a
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Fa� Arrival Time: Ef; Departure Time: County: Region: DO
Farm Name: Cqq ns Owner Email: 0`
Owner Name: %e _ Wad_— Phone:
Mailing Address:
Physical Address:Qyl
Facility Contact: 6aIe— weit Title: Ckn-fl' Phone:
Onsite Representative: (gene—_ h/el Integrator:
Certified Operator: S Certification Number: y5-(7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
111111
Design Current:,
Design
Gurrent
Design Cnrrent
Swine
Capacity
Pop"
a
Wet Poultry
Capacity
Pop,
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
` _.
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
'D _P,oult ,
Ca aci
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Boars
—.Non-Layers
Pullets
Beef Brood Cow
Turkeys
-
Other
Turkey Points
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NR- No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
allo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

►,
�Facility Number: ga. - Date oflnspection:_3f',1a.�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Ig Ig-�
Observed Freeboard (in): a2,—�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®' No ❑ NA ❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes CR No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes IQ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 12 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2g No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �TNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Con VV
13. SoilType(s): Q�yIC 60Idli A IS --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[::]Yes
Ej�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
®-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
Page 2 of 3
21412011 Continued

►f
Facility Number: a, - Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [R-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EE�­No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Cg-No ❑ NA ❑ NE
❑ Yes 5-No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes L o ❑ NA ❑ NE
❑ Yes
ER' -No
❑ NA
❑ NE
❑ Yes
®"No
❑ NA
❑ NE
❑ Yes
EErNo
❑ NA
❑ WE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments F
Use drawings of facility to better explain situations (use additional pages as.necessary:).:
Welt n,m-v s C ` t, ad9oze- reca& ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: cal ad 13
Date: QI a 433 `3 Ce
21412011

Facility No. a�"& • Farm Name _6%P, - Date 3 3
Permit COC 01C� NAPES (Rainbreaker PLAT Annua! Cert Daily Pipe)
Lagoon Name; S fors iliwa�
1
2.
3
4
5
6
7
Design Freeboard J Last Recorded in
Observed freeboard ; ':
Sludge Survey Date:
Sludge De th ftAA
Liquid Trt. Zone ft
Ratio Sludge to Treatment:Voldme if> 0.45
Date out of compliance/ POA? - I
d
0=10,70 1110 44 a
IMMMUSM
•
OMWAN
.NSM.
i�:������'
NFA�NFMI�t
Soil Test Date `J Crop Yield �_ Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed' WUP ✓ Dead box or incinerator
Lime Applied; Weekly Freeboard Mortality Records
Cu-1 ; Zn-1 1 in Inspections 7 Check Lists
Needs S (S-1<25) - 120 min Insp. Storm Water
Needs P Weather Codes
. .. ..
MOLJ J /f
_o1iMjit+.Jl
i _l .
Verify PHONE NUMBERS and affrliations
Date last WUP FRO: FRO or Farm Records
Date last WUP at farm: Lagoon #
App. Hardware I' `.'.° i Top Dike s3
a Stop Pump
Start Pump 36'1
Conversion-;Cu-I 3000=°106 Iblac; Zn-1 3000= 213 Iblac
iq
Ar
C3 1
`4
43
y.0

9141 -Uj �1131P,
Type of Visit: la Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 1"outine O Complaint Q Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: J-Jjjjjjj Arrival Timer Departure Time: Q p County: SaMejo,
Farm Name: G q- R 1 �/MJ Owner Email:
Owner Name: -P wet - Phone:
Mailing Address:
Region: F�—
Physical -Address: Gj�p� S, EiC��i�42 '�t (2IOYe
Facility Contact: -ji e4 -e— h��j"[ ' T' Title: to ww/' Phone:
Onsite Representative: Integrator: PI-eif ole
Certified Operator: Ge11t j'i/Pjt` Certification Number: -na
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
= Design Current
Swine •
aci o P
Design Current
s ,y Caci P
oult oP
Design Current
Ca i tyCa Pa P•
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P,oultr Ca aci P,o
Non -Da'
Farrow to Finish
Layers
Non -Layers
Pullets
turkeys
Beef Stocker
Gilts
Beef Feeder
Boars
I Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [RNo [:]NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [—]No
❑ Yes No
❑ Yes No
❑NA FINE
❑NA ❑NE
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility -Number: <M - wy I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lt_ _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
t• No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
fo No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2] No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): n r1I
ol
13. Sail Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
tR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
M No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freehoard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
NA
❑ NE
Page 2 of
21412011 Continued

Facili Number: 1 Date oflns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Callo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes gg"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
JgNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
15�-No
❑ NA
❑ NE
Comments (refer to:question ft Explain any YES answers and/or any additional'4recomme.ndations or any NMI
Use drawings of facility to better explain situations (use additional pages as neces_sarAv ,_
) s - �i ends r'?gyp_ (e4r
a0, C-eti+.' pNot' Insfti—rieuntl -,hay pet y4 bee�,7 Cali 6,0V' Nj6f V3cd( je
V i -h N wo,� _. 4e s I'll h f Calf Ixa b- y
oo, Newwo,E V(on has be. so)*jo vw&,
Terra-9 I Ue. NU fo I
�" l )Cai{`rm+ war C4-iCe
�Vel I ma i7io i�� --eam aid- j oA re (a -cal ,
Reviewer/inspector Name: d ' /] )w 14,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W -V .13 330 (Off7io l
Date:
1/4/10I1

Facility No. '5*r-�aN Farm Name
Permit -�,-COC 4�
Gq P.- �G/�S —Date Date
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
;
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
,}
Liquid Trt. Zone ft
4,0
5f
Ratio Sludge to Treatment Volume
r FFI-73 .T.1-71TWO."Ti m
Soil Test Date 1016 11
3114 a,
Wettable Acres ✓
RAIN GAUGE
pH Fields
WUP
Dead box o inera r
Lime Needed 0� @�
Weekly Freeboard
Mortality Records
Lime Applied �'�
Cu-I L/ Zn-I
1 in Inspections
120 min Insp.
Needs P 0--! 0
Croo Yield ✓"
S Q I
W4fe &OP
Weather Codes r
Transfer Sheets
t ilk 3°O,mgg�l
.
���
PAN
•
it
Window Max ate a Amt
�
Verify PHONE NU BERS and affiliations 13�.�' ���
Dlas WUP FRO Date last WUP at farm
m))
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac
iai e stag 18'0 -W r-::3 ►v a�-aso'�f
App. Hardware
-3 NOW rvrr),J AIS q
Peel
C-6
y3

Type of Visit: & Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: t9 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ' 1s County: SQLN 0#1 Region: Fi(�
Farm Name: fM''
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: 6H ,}, F P Q, b(Ove
Facility Contact: Cele Nei+ Title: ©wnt-�'' Phone:
Onsite Representative:
Certified Operator:
Back-up Operator: PA m da- NeTE
Location of Farm:
Latitude:
Integrator: P
Certification Number: )j� q a
Certification Number: ;�3(eQ
Longitude:
. ...
a urrent Desi n Current
Dp tg C
ee g
Design Current
P.AN
ry e
Swine Ca at Po �i'et Paul[ , Ca aci Pop.
ty
Cattle Capacity Pop.
Wean to Finish La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
C
"'` "
DairyHeifer
Farrow to Wean
Design
}Po_ultry
Current
D Cow
Farrow to Feeder
D Ca aci
Po
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
z , I
ITurkeys
Other
Turkey Poults
NJ
Other
jOtber
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 'R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
[—]Yes ® No
[:)Yes Ej No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: -45 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes D�[No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q _ 147
Observed Freeboard (in): aq _ '13
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes $2 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �R No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses'an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
M. Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LANo
(j NA
U NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
21 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C''No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
52-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
W No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NR"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CR NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[R NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ea No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond J�j Other: �I— C A---
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�3 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ca No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Fa -No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recomiffMiiions or;an} oth_ er comments. ill
Use drawings of facility to better explain situations (use additional pages as necessary) 114
V.Aao, Co,jet, ffVof Iota Ikqk_ -m?#-aA%Mal aV-m16,8l11, New foie pia, bier a"
Vi weI I M01* A4 -hm a, J_F 9cod reCodr
Reviewer/Inspector Name: J'�oln �' nip _ Phone: q!D`�CNUI�tC��
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

• Facility No%-XiIF Name nq Date
Permit ----�COC OIC NPDES (Rain breaker PLAT Annual Cert)
",1111mon
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
fr a(
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume
Design Width
Actual Width
�'-------
Soil Test Date 31� '$ Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed AQ Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I _ Zn-1 120 min Insp_
Needs P Q-kj A Weather Codes
Cron Yield Transfar ShPPts YyA,t0%in it al-1a1!'-3Im
Waste Analysis
ijp,,�",
�
Lqfo
Lq.gnvn
n��r�►�
6 i .
�Ir
..
tam
99��■�
mys[
` 0- ,r% -1
1 J
•:. j A
fro 9..
RIS Ar-'
a
�—
�
Verify PHONE NUMBERS and affiliations ott j
Date last WUP FRO Date last WUP at farm
4114 � ..50v�
FRO orl4rn Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Ib/ac
C0+10r't t, v ail'&&(e�
App. Hardware
C.),- Ff�

F.
V
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit VLRoutine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: ; Departure Time: County: Region: EM
Farm Name: _ FQ;,(r Owner Email:
Owner Name: CORA ✓ _ 1�y e!± Phone:
Mailing Address:
Physical Address:
Facility Contact: in?nP._W-ei , Title: aknel' Phone No: 395-970
+_— rt' Onsite Representative: _ C�7_eit _ Integrator: ftfL�dta
Certified Operator: Genp— W� Operator Certification Number: Is ±S6
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 0 « Longitude: o = "
Swine
Design
Capacity
Current Design Current Design
Population Wet Poultry Capacity Population Cattle Capacity
C•nrrent
Population
ElWean to Finish
❑ La er I
I
a' Cow
OR Wean to Feeder
❑ Non -Layer I I
a' Calf
ER Feeder to Finish
❑ Dairy Heifer
ElFarrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
❑ Pullets
❑ Boars
❑ Turkeys
Other El Turkey Poults
❑ Other ❑ Other
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes $a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
1.
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Page I of 3
1"
12128104 Continued

Facility Number:$ — a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CR No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 09 ''S 51
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
U No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IANo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
jj� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) coja al 1�Plmvda_ RQAto
, Small Gm,n 0vose4**A► nyol: C016-
ran
fo
3. Sail type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
tp No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R1 No
❑ NA ❑ NE
5'qM. - ,. x
Comments,k(refer to question'#): Explain any YIDS answers and/or any recommendations:or any'other comments.•
Use iirii ►i s 6f facili tAa better a lain-situatimns (nse additional as neeessa
'pages kr
I Reviewerllnspector Name Phone: I
jj
Reviewer/Inspector Signature: �� Date: SP�'�`�, a010
Page 2 of 3
i
12128104 Continued
q(0— 309- Out (Cell)

M
Facility Number: g a -aS11 Date of Inspection
• Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )j� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes N No ❑ NA [:1 NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard IRWaste Analysis ❑ Soi] Analysis P Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes fR No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 14 No
❑ Yes ❑ No
❑ NA ❑ NE
[� NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
P NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
asd/ora
Additional Comments anDrawings:
L GOO) V of-e-OV1 sef _ (Dl,
Q �! Oi Cov.4a � �jelm,d a, PAN rvos not eLe) ao)e berh
pleAed0 SI Jje.. WW1 aid- Cali �r t be6ye tq�d of yfw,
recce
C-ad job of eompl C� lh umer1'tiow k -Relh .
C 10a) -(blvM OJ- exce&r noW atoe 1 ive-1I �ft-F re co -di.
Cft f a,e i ns pedi a1 p Iti e � ILAb, - hq-i, eba,,� 1 ��' �- ro
6l2nbttt� �r611i4ercCty—La rc
4�°Jo Sde lo-ffaped poL
4*1jW d�ce s
oe h t1 vdme_ ovMa)�OPar/ o
ssde—
w
Page 3 of 3 12128104

Da-a�H
Facility No.`Farm Name
Permit / COC
Date
O C [""- NPDES (Rainbreaker
FB
Drops
"drAft"l—
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
$`
Ratio Sludge to Treatment Volume
q
1, ie M 4A
NOR- 01161.113-0
A Design Width
Soil Test Date SIiD
pH Fields (41
Lime Needed NO
Lime Applied
Cu-1 / Zn-I
Needs P 40-100
('mn Yipid
Wettable Acres ✓ RAIN GAUGE 4411�
WUP Dead box or incinerator
Weekly Freeboard Mortality Records
1 in Inspections
120 min Insp. �^ (
v �{�
Weather Codes
TrnncfPr ghPPtc ih.fr•- Q11`1 � t
%M /.. At (}%)T--!�9 19
1
lam/ �Lsi(a�
CAN! �
� 1
�
Verify PHONE NUMBERS and affi iations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records RQfh q�a8= Y'Q
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
� S6
LL3

Flo
bo,000
a �� alto
3
;3%irQ
a �
���
yl�ol[p
a �
,)CO
�Ifljo
3 I
bllS110
-3 1
3T°aCO
r5bOfo
3 )
of"o

--" 7. V) .
Type of Visit �0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency Q Other ❑ Denied Access
�� ( Departure Time: f �jj� County: Say, S� 1 Region:
Date of Visit: i�. Arrival Time: r
Farm Name: �4 R �Q%+1S Owner Email:
Owner Name: Phone:
Mailing Address: _641 S, �IGV1�/)P Nfw Ca1ti ��
Physical Address:
Facility Contact: ��A Title: q�P,hone No:
nneitP RrnrvcPntativP. 6"e'I� _ Y �J� J V TG-3 1yr—
Tn4a(sr9fnr• �r`J f71/il�
Certified Operator: CPAP w Operator Certification Number• AwA j gY
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1=10 ED ` ED" Longitude: [= ° E-1' 0
Design Current
Design
Current
Design C*urrent
Swine Capacity Pvpulati n
Wet Poultry Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish S`
❑ Dairy Heifer
❑ Farrow to Wean
'Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy_
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Nan -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Outer
❑ Other 1 1
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EJ-No
❑ NA
❑ NE
other than from a discharge?
12129104
Continued

Facility Number:'35 -psoDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[RNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:J —�
Designed Freeboard (in): q q a
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed
❑ Yes
[RNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
tR No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
21 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
CR No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[1�'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) C�U�101 D �QA ..�1.��r''�� ' Si7 05 `. �I�VYi �lb7+N�
L
13. Soil type(s) G NGA ' Pas)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CUNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA ❑ NE .
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DgNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerlinspector Name IQM Siw/Phone:a/01133-�3a0X��
Reviewer/Inspector Signature: Date: V
12128104 Continued

Facility Number: $ a$ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi gn ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No UNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
('NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[8No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E+lo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JO No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EfNo
❑ NA
❑ NE
T�! h a oo9
Pell "e�� b�� h Dct c)"' C�Yter �� wvs Cry rtr bra a�
ay. N 9
m P10ed C 0-fir. 0', u9001)
eodsl* -6,0"
r q - S vn?rrpi,
,�-fq
GDC� /(cavej- Gh d- well m a;lf�aPled fai
NWT `sha-fl a,dfleml C of
�la�n�� ~�-o C %
Page 3 of 3 12128104

Facility No. T)-3--)g y Farm Name _ 6q L Date 611110
Permit COC
Pop. Type Desi n Current
[f][e]
N PDES (Rain breaker PLAT Annual Cert )
—§Uudge Survey Date
Calibration Date
�-----
Soil Test Date J I E L 1 Crop Yield
pH Fields Wettable Acres ✓
Lime NeededWUP �
Lime Applied As' -(A Weekly Freeboa—rd ✓
Cu ✓ Zn ✓ 4160'l Rainfall >1"
Needs P 1 in Inspections �J
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Waste Analysis Date=�
. ,,, _
rs�
Pull/Field
Soil
Crop
R)(A
PAN
Window
Max Rate
Max Amt
—i
A'
-r15
"
�-�
D� `(0
�r
n
5D
-7,5a 156
w�� col
i00
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm,__uy�.o
or Farm Records q I! qI E7�
'lagoon
3
#
53,0()
Top Dike
Stop Pump
Start Pump
50��
App. Hardware
�
a P--Is-

F)EgS -71lrLol0g J_%s
Type of Visit Ef Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (SiRoutine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -7 j Q Arrival Time: Q'. %) Departure Time: ra� County: , Region: PAO
Farm Name: 4 , Owner Email:
Owner Name: Ong 1i*PcI 3r Phone: 67`-153'
Mailing Address: aS. Ekid Ww* Grove _ 0836
Physical Address:
Facility Contact: fr"ene k&t Title: Q%rn'Pl- Phone No:
Onsite Representative: Integrator: PiA'*" to
Certified Operator: GAtiP We* Operator Certification Number: tA-hA L UM _
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=] o [:] ' [:] u Longitude: E�] o Q ' 0 «
Swine
Design ''Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
A2q0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
- Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is -any discharge observed from any part of the operation?
f Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Cattle s-{
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures .. ,C
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
V. c. What is the estimated volume that reached waters of the State (gallons)?
r ' d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page], of 3
't
[-]Yes R'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[--]Yes [:]No []NA ❑NE
[:]Yes I'No ❑ NA ❑ NE
[:]Yes [�?•No ❑ NA ❑ NE - .
❑ Yes NrNo ❑ NA•,. ❑ NE,, ,4<
12128104 Conti�ueil SS r Wa;'

e
Facility Number: $ —a
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
IF*,!dfit b�IlHf (Icg
Designed Freeboard (in): q ( �!!
rr$
Observed Freeboard (in): Q L4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�FNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[8No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
HNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
12 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Eviddence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) COrb[n I Berrl,f�Q t1wPl G QS l'` 1�i hT117rL!r. CQiri
13. Soil type(s) GMA 6&o N061 k ka R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (SNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
EgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
DkNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
IS No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IRNo
❑ NA
❑ NE
& u
Comments {refertoquest,on#} �la�n any yESanswrs and/or any recomme ndatzoo'r any other comments.
[Ise draw_i€pgs of facility to,better ex'plaan s�fn"Ai W, `(use�addihonallpages as, ecessary)
yy h r
Reviewer/inspector Name S �/ Phone: q33 3 333331
Reviewer/Inspector Signature: Date:
pnao 7 of 7 1212RI04 Continued

� 1
Facility Number: 95L —ag Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IgNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ER NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5kNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
S 'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
t@ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�TNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
FNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
" o
QN
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CRNo
❑ NA
❑ NE
ini�h`al ins-h`oA-1
plegra✓ s�9 1 R R as 4t Cd 91d df cro f cy cle—
pl ea,,e_ Leeer c roe yields w t-h Ohl, r'lec&dj
GoaL 100kPWolf
-G r 4 ry�� mai4aj�1,�[ rec&ds
CaNb
a., �n aoa�, plans*-fip calf brace nfki'W'ek.
r
we - Qlv►s o b n e+v reef 4 W"W9 i exln�l rM4
1 reel (of �) Uf-f frrm wh6", +17riA
'Has not seard i", aow
Page 3 of 3 12128104

10 Fat;ility No. � Time In f S Time Out
Farm Name _ _S P, Integrator
Owner Site Rep
Operator No.
Back-up No.
COC Circle: General or NPDES
Date
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design a 3Z P p Observed
Sludge Survey N 4� q� S,g 3_3�.#-0• I Calibration/GPM 1 'Arl*" colorn `
Crop Yield ` Waste Transfers
Rain Gauge Rain Breaker
Soil Test41 Wettable Acres PLAT N IA- 0., j 1hr-0, $Q
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop '
Weather Codes 120 min Inspections
y3 q3 .56
Waste Analysis: low
Date -�11[l(N' o Date Nitrogen (N)�aef
.s
Pull/Field Soil Crop Pan Window
Cam, MN* �,nrn Coi jG► Q f DS
oom — Colo) w/4 os j Coda Goal f-

t
Division of Water Quality '
Facility Number S a ag 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: nnArrivalTime: i Departure Time: :�� County: SiTi" Region:
Farm Name: s 1`MS Owner Email:
Owner Name: Gin t a Wes Phone:
Mailing Address: 6 GS Sf /VWf ,-w 6roye t C- M69 - -
u
Physical Address:
Facility Contact: ��� Title:
t�
Onsite Representative:
Certified Operator -
Back -up Operator:
Phone No:
Integrator• Tres& e
Operator Certification Number: I8j
Back-up Certification Number:
Location of Farm: Latitude: = o = d = it Longitude: = o = 1 = W
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1 (off a
1 .33
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'!
Cattle
Design Current_,,.,ry
Capacity P.opulatton
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 3 1'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
❑ No
CFNA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
R NA
❑ NE
❑ Yes
❑ No
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
V9 No
❑ NA
❑ NE
12128104 Continued

Date of Inspectionl[S1p7 I
1 ��
Facility Number. 8A—
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
4 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
;� NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5'
Structure 6
Identifier: oZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 s S y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'Q No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J�j No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
F No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F1 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evvildence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) De,-+-," 6m s (14".ttis+,—), Sr,, CrI'• OW4'C 2d.,
1A)tn4e.-A`,n4+6.�
13.
Soil type(s) e
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
'
{P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
V9 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
U'6►o
4c&yd buf 5
Reviewer/Inspector Name ,ra`h le. Phone: /O
Revi ewer/] nspector Signature:I Date:
12128104 Continued

Facility Number: Vim. -- Date of Inspection S o'1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (M No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(Z] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
$3 No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EpNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Wo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
59 No
❑ NA
❑ NE
Comments and/or
12128104

►`7
0 Division of Water Quality
Facility Number 1 Q Division of Soil and Water Conservation
- - � Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance
Reason for Visit 4BRoutine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: O$ s0arr+ Departure Time: County: S�-++�SO� Region: FR
Farm Name: G 4 R Farms Owner Email:
Owner Name: ��� Y1 e 5, w e4 _j_f ' Phone: �/ 0, S67 4_319
Mailing Address: g �� ��� i /v"n rjC S ivt�
Physical Address:
Facility Contact: l 5S--J r' R- Title:
Onsite Representative. i
Certified Operator: l
Back-up Operator:
Phone No:
Integrator: Operator Certification Number: I N 56
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ I ❑ u Longitude: ❑ ° = i = W
Design,
Current
FQ,sign Cr urent
gn C
Desiurrent
Swine Capacity
Population
Wet Poultry pacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
9 Cl I
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
--,_
El Pullets
:. ❑ Turkeys
❑ Beef Brood Co
:.
Other
❑ Other
❑ Turkey Poults
❑ Other
Nurn6er'of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
6No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[X NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[3NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
qNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

rJ
Facility Number: a--Ae t{ Date of Inspection 1 7-A-06
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 15 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I VIX 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �jx94 y 50
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(iSNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JpNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
I�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;9 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of� Wind Drift ❑ Application Outside of Area
12. Crop type(s) W nt� �-thvU,[�Li t CDASW L".r VVj --&e 5^-A
GC[Y,.'
13. Soil type(s) G Q —� Ale
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R9 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
ZI No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Q No
❑ NA ❑ NE
,Comments (refer to question #): Explain any YES answers and/or any recommendations orrany.,other commenfs.
Use *drawings of facility to better explaWsituations. (use additional pages as necessary);.
nark - G4 Far -en, a�cce! --ec�/ { 3 k
r r
Reviewer/Inspector Name N Phone:C%�0 �33
Reviewer/Inspector Signature: Date:
rage Z vj J ► Z/G6/v'r UUMMUeu

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes YJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 156 No ❑ NA ❑ NE
the appropirate box_
❑ WUP El Checklists [I Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
V1 No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
2INo
❑ NA
❑ NE
Cl Yes ❑ No 4Q NA ❑ NE
❑ Yes
CA No
❑ NA
❑ NE
❑ Yes
`p No
❑ NA
❑ NE
❑ Yes [50 No ❑ NA ❑ NE
[]Yes Eg No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
12128104

0
k,
Type of Visit @ Compliance Inspection Q Operation Review O Lagoon Evaluation
for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ denied Access
Facility Number Date of Visit: 3 • TO-7i Tune: �P
1 O Not Operational O Below Threshold
,,,,,,,,,
�Yermitted Mil�ertified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ...------�..-...�--
Farm Name:-..C... �xc1!_. ...�. C��rx�.�..... �..... W .. _.� ..... County: . S.cr � $o.� ...»...».. ».....� .. �/?D.....
Owner Name. �i~:x� ......�'✓PS� Phone No:
Mailing Address:....Ir d�/i t .,� -�1Qd� 11���r� ...bl�. .......3.. .
s f " i �� GG
�n e e rt Phone No:
Facility Contact: ...............__...................�......-..I.._....._......... Title:......._W......................
Onsite Representative:... Integrator: P/{.4��.
Certified Operator:.._....._... C E.s ....._..k✓4-------- _ »» . _ .W.. Operator Certification
Location of Farm:
❑'Swine ❑ poultry ❑ Cattle ❑ Horse Latitude �• �4 G6 Longitude • ° °c
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ ................... .-....�....._.- ­­­­2
Freeboard (inches):
12112103 Continued

' Facility Number: Date of Inspection 3EO� l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
gTo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
(moo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
3NO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0'Ko-
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑W6
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[g-N'o
11, 1s there evidence of over application? If yes, check the appropriate box below.
❑ Yes
(INo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Qverload ❑ Frozen Ground ❑ Copper and/or Zinc
�`r �k /Yr C 1 /
12. Crop type L & - aef'wlel . W.•�., ", '4_ "1' -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Q-No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�o
b) Does the facility need a wettable acre determination?
❑ Yes
�`
c) This facility is pended for a wettable acre determination?
❑ Yes
[0Dio
15. Does the receiving crop need improvement?
❑ Yes
l946
16. Is there a lack of adequate waste application equipment?
❑ Yes
E[Ko—
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
AND
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑.>'io
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[9-
Air Quality representative immediately.
.Comments {reierto gtiestion #)Fxpiaiu suyYES answers and/or any recommendations Qr any other comments: ,m
:Use drawings otfaci'lity to better explaui s�tuatioas. {¢se aiidihanal pages as necrssary)
a�� -- - leld Co ❑ Final Notes
T
Reviewer/Inspector Nameafk
Reviewer/Inspector Signature: Date: 3 p- U
I1JIZ/D3 Continued

0
Facility Number: — Date of Inspection
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel W P, c, ccheckl` ice, desk, map etc.)
❑ Yes
E�l++ia-
23. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
[-No
❑ Waste Application ❑ Freebo✓ard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EIN6
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
aNlo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Cg-No
28. Does facility require a follow-up visit by same agency?
❑ Yes
EKO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Q-1"do
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
MA%s—
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q-Nb
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M-No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
O-K-o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Epio`
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Fop ❑ Crop Yield Form ❑ Rainfall Inspection After 1 " Rain
❑ 120 Minute Inspectionsy[] Annual Certification Form
12112103

' Site Requires Immediate Attention:
Facility No. ? -701
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: `7 / S) , 1995
Time:
Farm Name/Owner: pigi`
_u= -�
Mailing Address:_ �h /��32 ,�_.r/Qvx__('.E_
County:`
Integrator:
On Site Ri
Physical Address/Location:
Phone:
Phone:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: -d Number of Animals on Site: �.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) r No Actual Freeboard: -,;'- Ft. Inches
Was any seepage observed from the 22,00n(s)? Yes or M Was any erosion observed? Yes or
Is adequate land available for spray? � Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: -s
Does the facility meet SCS minimum setback criteria? 200 Feet from
or No
100 Feet from Wells? CY4 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o 1>
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or6$ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?(Ye or No
Additional Comments:__.. w ed _ rh V i""'j F koL-%* I e J, _V
C4CLr1t-5- ' I)fIt 7
Inspector Name
AK
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

HDRT$ CAROLINA DXPARTMZNT OF EMFIRONMENT, HSALTS do NATURAL PJCSOMM
DivISION OF ENVIRONMENTAL MANAGFNET
Fayetteville Regional Office
Animal Operation Compliance Inspection Farm
�: .. � •. tY4R :iVLli.b/.i�1�1�LC'i ~'3 ti'q 'i
;'�1iW iCIN MiF!.:
G R Farms Gene Wes+ "-A
�� w }�II+��a..�ii... A�•n� ���r+�TY:� �NE�:���R�'°°" w
�„ a�a��'4,t�
P. O . gox 5 3A KCVACn GMVf_ qrp- 5&'1-5319
3jrj,
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permfttee to perform the appropriate
corrections:
SEMION I
Animal oraration TYDe: Lx-_ae i- TO Ffnish
Horses, cattle, Kin , poultry, or s.'seep
SECTION II
Y I N I COKKENTS
]. Does the number and type of animal meat or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
systam)3
2. Does this facility meet criteria for
Animal Operation AEGISTRATI�?
3. Are animals confined fed or maintained
in this facility for a 12-manta period? -
4. Does this facility have a CERTIYTM ANIirlAL
WASTE NAMAGEliEW PLAW.
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

r �
. S�IOP III
rield Site Mara neat
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USG5
Map Blue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a USGS asap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance with the
CERTMCATIM _ p7+p1P 7
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
ar other similar mats -made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved M
tTMCATjW*
7_ Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately )
8. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION rV
Camment5

r - f
46
R G:5T T:QN FORM FOR ANIMAL FEEDLOT O?ZPA :QN5
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If tie animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 73
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this farm :rust be fi'_'_ed cut and :nailed
by 0ece:nber 31, 1953 pursuant e 1=A NCAC 2 .0217 (cl in order to be
deemed permitted by DEEM. ?lease print clearly.
Farm Name:
Mailing Address
Caun ly In
f Phone No
Owner (s) Name: _ ��it` c �.f �C,74,Jr,
Manager (s ) Nare
Lessee Name:
Farm Location (Be as specific as,eossible: road names, direction,
m1lepost, emc.): AA 42 0
0L ispi Ante � � 3 '.., "Its
Lat==ude/Longi ude if known. -
Design capacity of animal waste mana
cf confined animai (sl) s nVann Z
-
on foon's
systeaa (Nifer and type
average animal__ copulation on the farm (Number and type of animal (s)
�,t
-raised) : �II F_ AS 4_�'L.s`r
_19 �9 ASCS Tract No .:
Year Production Began: -
Type of waste Management System Used: ) 411/0
Acres Available for Land Ap_ lication aste : W _
Owners) Signature (s ) : xr )2x-, OATS: '-.29-9.3
:s-,9-93

WORTH CAROLMRh D"ARTM30T OF , HIKALTH & NATURAL RESOURCES
DMSION OF IMTRON)MTAL
Fayetteville Regional Office
Animal Operaticn Compliance Inspection Form
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All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Aniol oaerat on -Type: e� -�o R6jSI
Horses, cattle, swine poultry, or sheep
5EC"T10N II
Y I N I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) Criteria? (Cattle (100 head),
horses (75), Swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIPIF.D ANIIrlAL
WASTE l4AN gZkgW_ P%APP
5. Does this facility maintain Waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
6. Does this facility meet the SCS minim=
setback criteria for neighboring houses,
wells, etc?

sK=OX IIx
Field Site Mara ement
1. is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
May Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS dap
Blue iane Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CXRTIFICATION PLANT?
5. is animal waste discharged into waters of
the state by maxi -made ditch, flushing system,
or other similar man-made devices?
6. noes the animal waste management at this
farm adhere to Best Management Practices
(WIN of the approved TMgkTION?
7. Does animal Waste lagoon have sufficient
freeboard? How much? {Approximately _ }
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SBGTION rV
Comments
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.1 7'" iV.-S':'3 - PIAN C RT=7=.^AT=CN a?CR MRW OR ,.=AYAM= 7W--7= `3IS
21aase =StU-= the co=pZatad to= to t=r Divtaion of 3av'.=*==Ga+-aZ `sa &g8=ant st
^tea and-oaa on the rsvar'a a'_de of tb.!.a :faa_
Name of fa_� Please pr_. t) : G �' 4 FARMS W .5
Address: P. O_ 3c k S 3 2-
--
_ W.V 7. a 04gyC AM 2 WA" Phone No.: g In - 547- 53 J 9
County: 5a�nv5
=ate location. Lap_Y.:de and Longitude:.` /3' ems' /7r Zq' "{r_s_j_eG)
please attacha copy of a county road man with location identified.
-,,e of operation (swl-ne, layer, dairy, ecc. ) S%&JInE
yes ice__ capacity i- .m`"er of animals) Z940 FED - 0�in115 K
Average size of cperat_ n Q2 mcr_th population avg.) 29•ta F--£yn
Average ac_aage :ne._ded for land application of waste (acres)
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.ec�ica� S�acialiat Ca�_c�icatioa
As a =*=A._cai s-ec_a;:ist designated by the North Carolina Soil and :dater
Canser:ation Commission ju=suant to M NCAC or .0005 - certify that the rev or
xpa,ded animal waste management systam as &-palled for t.e fY W .^_a-ed a.:ove
;as an an! -al waste. =a^agemerc plan that heeds the design, C^�5r=1Cti_^.ri.
cpe_ation and =mL=te.amnce standards and Specifications of the Division of
=v!or=ental Mara;,eme_ r- and the UWA-Soil Ccnser-ration Service and/or the °Yon y-
Cazclina Soil and riace= Ccrservation C==missicn pursuant co WA NCyC 2H.0217 and
151 NCIC 5r .0001-.fl005 The following elements and their corresponding t;.n
toria-i�a lee_^._fe=-=1ec �y me or -other designated technical specialist: ar.d
awe include" in the plan as applicable: mi nimum separations (buffers) ; liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and am.ou:t of laud for waste uzili_ation (or use of thi=d :arty); access
or ownership of proper :caste application equipment; schedule for ti-i_ q of
applications; application rates; loading rates; and the control of the discharge
of poilutancs fraat sto _water zonoff events less severe t:-.art the 25-year, 24-hour
scorm-
:=amp of Taco^s cat Spec4a14at (please pz-inZ) C1. GLEnn CLt FTo*1
Affiliation :-- 0013704.GE F,o RMs . Sri_.
Address (Agency) P.O. GinT C jffjZA Phcne No.9/0- 5-92--577L_
Signature: y. ANK-a 1001— - Cate. 311-7 195
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( :e) Underszard the operations and xai: penance procedures eszahlis ed z;: the
approved ani-al waste ma.nagemenc place for the fa = mame_ above and will _ lament
these 7rocedrss. - (ire) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or c_rsc^cc_;ors of new
fac__wp_es will req:j_e a new certification to be suhmitpe~ po t_ a Divisor. of
_SVt oMMe_=zal war_agement before tine new anOMals are smocked. _ (we) also
aderszand that there =ust be no discharge of animal wasca f=== this system t'
surface wacers of the state ei-.^ter t:-xaugh a :rar.-:jade convevan:=e or th=cug'h
_....off i_oQ a stagy even less severe t a=. the 2S-Year, 24-.^_CL'= storm. T!ne
amp -over plat_ wil! =e riled at the far= and at the office of _coal Sall and
Water Conservation Dist=_at.
5Ya_:.a of M.Md C4r_aa= Please print) 4z� 6 &4g, S. y4gg rr TX
Sig at_re- J Date:,
Na :a at *laaaga..r, if di=ferenc from owner (Please print)
Sj;:.atire Date:
q.z : a change in land curnershlp recuires nccif-canon or a now cart-f-cacicri
(if the approve_ plan is c?:arged) to ie submitted to t :e :;i-is_cn c=
Z:ri-�zr^ental Management within 60 days of a title transfer.
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