820354_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

3l (AS -11
t
Type of Visit:om fiance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S4 WS'01V Region: Ftz-o
Farm Name: N I r / ecy 44 S' Owner Email:
Owner Name:�� Y t j�lc� a Phone:
Mailing Address:
Physical Address: s
Facility Contact: C 0 �1 S ��GL /'C4-,Ibli Title: Phone:
Onsite Representative: 4l
Certified Operator: - i YLVK t S
Back-up Operator:
Location of Farm:
Latitude:
Integrator: N 13'--5
Certification Number 0 9 Q ;ff
Certification Number:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
❑Yes � ❑NA ONE
a. Was the conveyance man-made? [:]Yes ❑ No Q—NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No DIA ❑ 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 [3"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3 -No 0 NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [D"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 2/4/2015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pap,
Wet Poultry
Capacity
Pop.
Catt#e Capacity Pop.
Wean to Finish
Layer
RNon-Layer
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
-ZiOoo
Design
Current
Dry Cow
Farrow to Feeder
D Poul
Ca aci
$o P.
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
❑Yes � ❑NA ONE
a. Was the conveyance man-made? [:]Yes ❑ No Q—NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No DIA ❑ 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 [3"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3 -No 0 NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [D"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 2/4/2015 Continued

nnj
Factli Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J'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
❑ NA
Identifier:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'No
Spillway?:
❑ NE
acres determination?
Designed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
Observed Freeboard (in): 2p
02 0
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 -go- ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Erg ❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
the appropriate box.
If any of questions 46 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
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E'N6 ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
9. Does any part of the waste management system other than the waste structures require ❑ Yes [34fo-- ❑ NA ❑ NE
maintenance or improvement?
Waste Anplieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
D PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windrow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G 1'i "'F
13. Soil Type(s): wcu PV q tI ri-
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes [ ] o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D Ko
❑ 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
02 0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EKO
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Er<o
❑ 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 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
FZ/No
❑ NA
❑ NE
Page 2 of 3
2/412015 Continued

in
IFacWty Number: -5I Date of Inspection: uN�
24 oDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
.125. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ -Ko_ ❑ 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 [Z>6 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [9 -lo ❑ 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:
DYes �o DNA 0 N
❑ Yes [�o ❑ NA ❑ NE
❑ Yes D -N -o— ❑ NA ❑ NE
❑ Yes Quo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2-lGo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
[D Io
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Quo
❑ NA
❑ NE
i
Comments (refer to question #j Eaplaui,any YES-answerssand/or,any additional recommendations or, any otliiergcoinments.'�
Use drawings, of facility,to_ bexl­
tter ezp_latn situations (ase additional pagesasrnecessaryj .;
C-11all C7 sl ay gt-
3o
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:[phone]
Date: 26 Ju u -r. M
2/4/2015

(W a 6 tlti. l-In
5
(Type of Visit: Q -Com lance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: jS County: 0-("t Region{Z
Farm Name: d�y� r�r �f Owner Email:
—r'
Owner Name:�1�1✓AC :Sf3 Phone:
Mailing Address:
Physical Address:
Facility Contact: [s; 0 ovwt-'A Title:
Onsite Representative: '
Certified Operator:
t �
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
f 1b � D
Certification Number: 8
Certification Number:
Longitude:
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?
❑ Yes NA ❑ NE
❑ Yes ❑ No Ea -NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design
C►urrent +� "�Des�gn
Current
IIIREDesign Current
c. What is the estimated volume that reached waters of the State (gallons)?
Capacity
Pap. Wet I'o E r Ca' acs
Po p
Cattle t Capacity Pop
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
NA
_
Wean to Finish
❑ Yes
O&FTLayer
❑ NA
Daia Cow
Wean to Feeder
❑ Yes
= Non -La er
❑ NA
Dairy Calf
Feeder to Finish,
Dairy Heifer
Farrow to WeanZct
Q�L' J Des.�gn
.=Current
D Cow
Farrow to Feeder
=Drv:Poultry ' Ca
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
K " Non -La crs
Beef Feeder
Boars
Pullets
Beef Brood Cow
-,.
Turkeys
-:.._
other -_
Turkey Poults"
Other
4
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?
❑ Yes NA ❑ NE
❑ Yes ❑ No Ea -NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[f] 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 part of the operation?
❑ Yes
[ 'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
['SNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2075 Continued

Facili Number: 7!5c( jDate of Inspection: 9 • kt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 -K -o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ea4o- ❑ 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 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 E3 No ❑ NA ❑ NE
S. 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 E:rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
1 l . 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 dWindow ❑ EvidenceofWind Drift [:]Application Outside of Approved Area
12. Crop Type(s): �j �r S( C lT
13. Soil Type(s): i��ais✓1
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 []'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ejlf�4o ❑ 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 [2'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [:JlNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F-/rNo ❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes DINo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - ;3 ,5' Ds ection: VS
24. Did the fgcility fail to calibrate waste application equipment as required by the permit? [:]Yes &No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IJ' - o
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 [;kl�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []'No
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 the 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E2 -N6 ❑ NA ❑ NE
❑ Yes E] -No ❑ NA ❑ NE
❑ Yes E3, -No [DNA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
❑ Yes C3'Nlo
❑ Yes ❑filo
❑ Yes D -No
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C,rtUI6A- -i--- - 6._��-rs
Cat qta - �O�-
Reviewer/Inspector Name: f� i c(
A1:1 n
Reviewer/Inspector Signature:
Page 3 of 3
Phone:ck)-T 33 15
Date: 9-15 n 1
2/4/2015

I1,.&1 a ) wrVi)c
Type of Visit: 0Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 4EYkoutine O Complaint O Follow-up O Referral 0 Emereenu O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: J County: :— Region: 74
Farm Name: _ j� �h ��Aae_IWj - Owner Email:
Owner Name: 1" (kc a Phone:
Mailing Address:
Physical Address:
Facility Contact: 12 P "tli ' Title:
G`
Onsite Representative:
Certified Operator: ItE
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
m 6 -5
-
Certification Number: l &O d04
Certification Number:
Longitude:
Design Current Design Current Design Current
Capacity Pop. Wet Pty Pop.inish La er Da' Cow
❑ NE
YNA
❑ NE
Feeder
Non -La er
Da' Calf
Finish
Wean
Feeder
aGilts
Dai Heifer
Design Current D Cow
D , I;oult . Ca aci Po Non -Dairy
La ers Beef Stocker
Finish
Nan -La ers
I Beef Feeder
El Boars
Pallets
Turkeys
Beef Brood Cow
Other
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)
❑ Yes [El LS'"r' ❑ NE
[:]Yes ❑No
[:]Yes ❑ No
g?�1A
❑ NE
YNA
❑ 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 ZNA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes [�&o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ill No ❑ NA ❑ NE
of the State other than from a discharge? r
Page 1 of 3 21412015 Continued

04
Facili Number: - Date of Inspection: QZ? Ke'
�E.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? r] Yes ❑ No [3J 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 2<o ❑ 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 (;Ko ❑ 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 Q.14b ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ido ❑ 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 [21/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D10 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O/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 Cro Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): 91� 15 G 0
13. Soil Type(s): 4)4- A e W�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
❑ 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 ❑ No
❑ Waste Application p 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 ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1 =1 NO"o ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes []k1Qoo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [40 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E;@ 4' ❑ 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 E6/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 [f' 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 [R<o ❑ 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 �o ❑ NA ❑ NE
ts.(refer to uestion ft Exp --lain any YES answers and/or any additional recommendations or.anyother commehUq
m-gs offacility to better explain situations use additional pages as necessary). -
-
s
Reviewer/Inspector Name: �1 Phone:
t
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

Type of Visit: 1),=0utine
Hance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint O Follow-up Q Referral 0 Emergency 0 Other O Denied Access
Date of Visit: J' Arrival Time: Departure Time: County: S Regionl f✓'�J
Farm Name: S Owner Email:
Owner Name: t kc Phone:
Mailing Address:
Physical Address:
I
Facility Contact: Title: Phone:
Onsite Representative: �� Integrator:
Certified Operator: - [+� 1—`0 0'r Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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 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 [_N _❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes e'�lo
❑ Yes ET -No
a -KA ❑ NE
CI -14A ❑ NE
[TNA
❑NE
❑NA
❑NE
DNA
❑NE
Design
@nrrent- .,.
Design
Current ..
Design Current
Swine
Capacity
ir
Pop.'VetPoultry:
Capacity
Pop
Cattle, Capacity Pop.
Wean to Finish
I
Layer
w
Dai Cow
Wean to Feeder
Non -Layer
Da Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
• Op0
Design
Currents
Dry Cow
Farrow to Feeder
Dr PU1
Ca aei
P,o .
Non -Dairy
Farrow to Finish
_
Layers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other
Turke Poults
-
Other
I 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 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 [_N _❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes e'�lo
❑ Yes ET -No
a -KA ❑ NE
CI -14A ❑ NE
[TNA
❑NE
❑NA
❑NE
DNA
❑NE
Page 1 of 3 214/2011 Continued

Facility Number: - Date of Inspection:'AA
No
❑ NA
[3 NE
Waste Collection & Treatment
E]"No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D_Na__E] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No IA ? A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
.Ale- D 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
C --Nn-- ❑ 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
❑-NU ❑ 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
[]IVB- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ -Na— ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-1`o' ❑ 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): 1j iPvw"_J't s C 0
13. Soil Type(s)
2w
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 �o ❑ NA ❑ NE
❑ Yes I_`_f'"O NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes
No
❑ NA
[3 NE
❑ Yes
E]"No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [.:INo ❑ NA ❑ NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes filo
❑ 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? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E-] gNo
Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cfl-PFo—❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Ala—❑ 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [][-?46— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3 1"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E 1�a
❑ 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
F-9-5o_
=15o
❑ 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
E3 iso
❑ 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
0
❑ 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
E] NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Fe o
❑ NA
❑ NE
Comments (refer to question•#) Explain any YES answers..andfor any addttlona !-t&ommendations or, any, other comments. " a
Use drawm�s'of facilirir 't _betf6Fexnlam situations (use additional
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
01
Phone: - 1•T
Date: +d`
2/4/2014

JPS �• w... �rw... uMc XUBPULAM" t/ vpca auou nVVIcW %,.f 12 U"UJr rJV4JRaalau V iIF%,UU .aa r a3laLnl c
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:, Arrival Time: — Departure Time: J /�o(J� County: Region:
Farm Name: rj v" tire f T�t,1iV-'--V Owner Email:
Owner Name: l kc '/-611) Phone:
Mailing Address:
Physical Address:
Facility Contact: �!
Onsite Representative: U
Integrator:
Phone:
Certified Operator: - CK ff,014ft Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
DesiBe gn
Current
- Design Current
❑ NA ❑ NE
Design Current
Swine
Capacity Pap.
Wet=Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
Layer
❑ Yes
❑ No
Dai Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Feeder
Non -Layer
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Da' Calf
❑ No
o Finish
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ISI
Da Heifer
3. Were there any observable adverse impacts or potential adverse impacts to the waters
to Wean
R
Design
Current
D Cow
to Feeder
Dr.,�P■oultry
Ca aci_
$o
Non -Dairy
EFarrow
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
s
Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
❑ 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)
❑ Yes
❑ No
g4A ❑ NE -
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ISI
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[ No
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number:Date of Inspection:
1W -
Waste Collection & Treatment
4.4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 9_K9_1❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑.Ko ❑ 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 El Yes [3'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 environm��at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes L . ❑ 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
ff No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
o [INA
❑ 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 Window [] Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s):% 5 CD
13. Soil Type(s): W
14. Do the receiving crops diVer from those designated in the CAWMP?
❑ Yes
`fir NA
F] NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
o ❑ NA
F] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EA Ai ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes[-io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6,Ko' ❑ 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 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facfli Number: Date of Inspection:'
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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 property 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
n -f1 ❑ NA ❑ NE
EJ'Ko�gl�'A ❑ NE
❑ Yes
[ rloo
❑ NA
ONE
E]Yes
13 -No
1:1 NA
0 NE
Yes P -K.' ❑ NA NE
[:]Yes No D NA NE
Yes is [:] NA NE
Yes [r No D NA NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Po [DNA [:] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes V NA ❑ NE
34. Does the facitity require a follow-up visit by the same agency? [:]Yes [5/No NA ❑ NE
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3

i ype ul v isic upr%.ompuance tnspecuon v uperation tcevtew v notructure Evaluation V t ecnmcai Assistance I
Reason for Visit: routine O Complaint O Follow-up C) Referral O Emergency O Other O Denied Access
Date of Visit: t{ a Arrival Time: Departure Time: :ab M County: Svc Region: i%Ra
Farm Name: q g Owner EmaH:
Owner Name: E_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1&ARL jZ.Q K Title:
Phone:
Onsite Representative: Integrator: T e91 j
Certified Operator: _- N�s�C4 �r� Certification Number:
AW4— 59tla-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Im acts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
K 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 [v] No ❑ NA ❑ NE
❑ Yes [3�No
❑ Yes g No
❑ Yes [� No
[:]Yes dNo
❑ Yes [(No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Daiiy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean p O Design Current
Farrow to Feeder
D , Poul.
Ca acih'
P.o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Turkeys.
Other
Turkey Poults
Other
Other
Discharges and Stream Im acts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
K 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 [v] No ❑ NA ❑ NE
❑ Yes [3�No
❑ Yes g No
❑ Yes [� No
[:]Yes dNo
❑ Yes [(No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: gol -.3 EIL4 Date of Inspection: e 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [vfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [yNo ❑ 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 [ZNo ❑ 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 ff No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 [2'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [fNo ❑ NA
❑ NE
maintenance or improvement?
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
p 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): _� �(Ze�vsC�A 6AA?y_) �s, (_, O
13. Soil Type(s): `3 AGR A i'll ONO i1�t�R . d -�oJ or
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes [E f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [i"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 [�rNo ❑ NA ❑ NE
[:]Yes [2rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [TVo ❑ 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 0 Maps ❑ Lease Agreements ❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [TNo
❑ 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 gNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facilit Number: S& _ I Date of Ins ection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [jj"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;3'No
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 1No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes UNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes
0'No
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
CE3 No
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"No
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
[EfNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R(No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
dNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA .❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to "' . �.r,_
( question::#.) ,Explain anv:Y£S answers and/or any additional re any other comments. -
Use:drawings of facility to better explain situations (use additional pages as necessary)z_�.
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 0.�1J •`• Ln�S
Date:
,2/412011

tvis`ioii;;of Water Q'tiaiity '
Facility Number - S Division of Sail and Water Conservation
QQ sthc Agency
Type of Visit: ercompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: tine Q Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit:W�10
Arrival Time: ' Departure Time: d County: Region:
Farm Name: f1 4 Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact:7�,,� i L �1 Title:
Onsite Representative: ,'�.
Phone:
Integrator: I�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2<c, ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
Q'ftA [] NE
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No []'3vA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes io ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
Design Current
�'` Design Current
Design Current
SwineCapacity
Pop.
Wet Pouitey _= Capacitys a Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
(j
Des�gnCurrent
�`'
D Cow
Farrow to Feederp.
F
INon-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other11AIIJITurkey
Poults
11 Other
��....SIR!
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2<c, ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
Q'ftA [] NE
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No []'3vA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes io ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

lFacility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U31<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2-<o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA
Spillway?:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
la
❑ NA
Designed Freeboard (in):
the appropriate box.
Observed Freeboard (in):
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CEJONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Sludge Survey
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspectii�KOPIE]
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
�o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[] No�3TA
❑ NE
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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Lg,<o
❑ 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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2-110
❑ 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): (f­meru � L�) &—, n -
13. Soil Type(s): f �,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ea"N' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E]�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[t]'1\10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ef No
❑ NA
❑ NE
Reuuired Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
la
❑ 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
Eio
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Sludge Survey
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspectii�KOPIE]
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No�3TA
❑ NE
Page 2 of 3 2/4/2011 Continued

iFaciliNumber: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2<o ❑ 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
[:]Yes
[g1Vo
❑ NA
List structure(s) and date of first survey indicating non-compliance:
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
/
02' ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[] No BTA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
ffNo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ Yes
[],<o
❑ NA
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[g1Vo
❑ 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
[],<o
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Z o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
UKo
0 NA
❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/2011

-21-2040 'V"317m s -- i - zz - 2-0/ 0
3.
Type of Visit &C-o—mpliance 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: V —21 Arrival Time: % D Departure Time: County: f�__b N Region: `��
Farm Name: 1-e Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Luy� 5 SgKWIL-K Title: . S�Pe✓C- Phone No:
Onsite Representative: elak/ 5 J&e%y t �� -� Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =1 o El I = u Longitude:
Design Current
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ Layer
ro
❑ Dai Cow
❑ Wean to Feeder
Non -Layer
a. Was the conveyance man-made?
❑ Dai Calf
❑ No
❑ Fe der to Finish
❑ NE
❑ Dai Heifer
Eg-farrow to Wean 20D0
Dty poultry
❑ D Cow
❑ Farrow to Feeder
'° -
❑Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -La ers
❑Beef Feeder
FoBoars
❑ Pullets
❑ Beef Brood Cowl
❑ NA
ElTurke s
Other
❑ Turkey Poults
❑ Other
❑ Other I
umber of Structures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ZN,
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[I No
L] 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
2<o"
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EMo
❑ NA
❑ NE
other than from a discharge?
12/2$/04
Continued

Facility Number: 82 — s Date of Inspection 21 �Y4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,�, /No
El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
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?
[3 Nc
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
t at, notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ Yes
NNoo El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
�
LTNo [I NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
IT Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require ❑ Yes
L,/ No ❑ NA ❑ NE
maintenance or improvement?
El NE
Waste Application
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E2 No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,��
[3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window' ❑ E'vid)ence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Lew dam. L '� v sW^- GY i 5 L6 S •� /rye SC'u C_
13. Soil type(s)
I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
EINE
15. Does the receiving crop and/or ]and application site need improvement?
❑ Yes
[3 Nc
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
[,o
[INA
ElNE
IT Does the facility lack adequate acreage for land application?
ElYes
L N
El NA
El NE
1$. Is there a lack of properly operating waste application equipment`?
❑ Yes
No
❑ NA
❑ NE
.;
Comments (refer to question #) Explain ani YES answers and/or any recommends"t]ons,or any other=comments - u
Use drawings of fa lC �iy toRbetter expiatn: sitnsho s Muse additional pages as necessa
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone: 910,?33..3 s0
Date: 1—,21-2010
IZlZaVU4 c.onnnuea

Facility Number: 62 —3.5-A Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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. ❑ WUp (l Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LfJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L`1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/
[:1 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E N
El NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E4El ElNA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
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
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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No [:1 NA
❑ NE
Additional Comments and/or Draw�ags
]2/28104
]2/28104

32:0ts efl,ll-•-le-ls1 /0 -oz --4601'
Type of Visit @-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time. Departure Time: r�: �}f'9,� County: S4t3C &, J Region: ffleV
Farm Name: '77,�&_ �4r�i9_j _ Owner Email:
Owner Name: _AKe_ /10O•'e— Phone:
Mailing Address:
Physical Address:
s
Facility Contact: 't V+ 5 �jGiY�iG K Title: �_ ec-A. Phone No:
Onsite Representative: O Qr+'s 8aLy,.1r c_k Integrator: � hn r -i c_ Fctrw�5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=i
=gd Longitude: =0=C
°=C =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry. Capacity Fopulation
Cattle C►apacity Population
❑ Yes
❑ Wean to Finish
10 Layer
❑ NE
iry Cow
❑ Wean to Feeder I
ILI Non -Layer
I I
i Calf
❑ Feeder to Finish
El No
airy Heifer
Farrow to Wean 26co
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
2<A
❑ Non -Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
El NE
El Turkeys
ElL` Yes
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,
LR<o
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
,, �_,//
L" I No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
,��,,//
L'7 wA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
2<A
❑ 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)
1:1 Yes
No
,,.._..,,//
R<
El NE
2. Is there evidence of a past discharge from any part of the operation?
ElL` Yes
�❑],
1qog�
[:]NA
[INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,
LR<o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

w �
Facility Number: 82 5
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes B o ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3& „
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes PTNo ❑ 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 B<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D ❑ 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 [:INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L7No ❑ 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 El Application Outside of Area
12. Crop type(s) r to dc. ,45 ^441/ CPg1'Ai eV -5% reSCU
13. Soil type(s) _ d t�.it 1\1,)A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
���
o
[INA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,E
Ng�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
,L��'T,,
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesI—
�LfNo
�,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No�
[31<o
❑ NA
❑ NE
Reviewer/Inspector Name I f�iGKe.�f Phone ��0• 5�33�353f�
Reviewer/Inspector Signature:- Date: `� `23 -tea
Page 2 of 3 12/28104 Continued

s
Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have 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. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
ON.
❑ NA
❑ NE
❑ Yes
EINoo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
No ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Yes
❑ 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
' <o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
[INA
[:1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El2 Yes
,01
o
[:1 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Lhgo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
E]B Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O 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
L] 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
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
No [:INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
,��
93 o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2"No ❑ NA
❑ NE
12128104

i_ 3.iAA!, 9-04-06 RP,
Type of Visit (3<o-mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 9. `f9 Ary County: Region: I lee
Farm Name: " Al,, i5� ` *-04S Owner Email:
Owner [dame: /N�e _y`', Q_ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Crlr f % S egrW c_k Title: 7� Som, //^^ Phone No:
Onsite Representative: (fai, �1 s L��� : c,fe Integrator: Co 4 aj-je__
Certified Operator:
Sack -up Operator:
Location of Farm:
Design Current
Swine i Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
LI Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Sack -up Certification Number:
Latitude: = o =I 0 Longitude: = o = =
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Destga Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:,{ -
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 El"No ❑ NA ❑ NE
❑ Yes
❑ No
L l NA
❑ NE
❑ Yes
❑ No
[3<A
EINE
E<A
El NE
❑ Yes
No
Yes
ElL
,❑l
7,fv�o
❑ NA
❑ NE
El Yes
EK
❑ NA
❑ NE
Page 1 of 3 12128/04 Continued

.er
Facility Number: r2--3S1f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
3iTo
❑ NA
EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Riqo--
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eh1
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
El Yes
,���
IS 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
B <o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
B o
❑ 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
aNb-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,��
ET No
❑ NA
❑ NE
mai ntenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes Ivo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑} Evidence of /Wind Drift ❑ Application Outside of Area w 4
12. Crop type(s) ,Pw.-+u .%�.. �C?r: c ✓ � ��C9�'4�.✓ �O. S.� / rJ"C+�/G f6ia'1 G� Nr.kt.- i lti+.l�s _ /`�NKci4.�J
13. Soil type(s) go $ , Wa_ B & /4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R
o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes BIC ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0-<o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Good
Gr:,Ci
I
❑ Yes Imo ❑ NA ❑ NE
❑ Yes 0'50— ❑ NA ❑ NE
Reviewer/Inspector Name ,.� }2e, ye (s °'° =-;� Phone: q%17, f#33, 33. 4
_ R - _
Reviewer/inspector Signature: R ",— Date:
Page 2 of 3 12/28/04 Continued

Facility Number: 82 -3S Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2ITo- ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes B< ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9<o ❑ 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 a o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2lo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
©'lo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3wo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑-Wo_
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,--��
G o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0go—
❑ 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
3<o
❑ 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
B<
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
El Yes
�/
Lhlo
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
011'o�
❑ NA
❑ NE
Additional Gorssid/orDrttwutgs�
Page 3 of 3 11/28/04

F�
I3..TA(_r 9-17-07 R�e_
® Division of Water Quality
Facility NumberS Z 3SSI Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit *Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit m Routine Q Complaint 0 Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: —Ij - d Arrival Time: /Z ; ZS' Departure Time: County: OSS+✓ Region: IC.Q0
1
Farm Name: !- i Owner Email:
Owner Name: !, Q— Phone:
Mailing Address:
Physical Address:
Facility Contact: err-�iA�r [_ Title: Phone No:
Onsite Representative: eze,-- i i 1 .zy,. .,, Integrator: 1 D�evi'c lis S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =1 o= I 0 u Longitude: = 0 0 I F7 W
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 7000 d p
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Disc^ har2es & 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Coy4
Design Curreni
Capacity Population
Number of Structures:
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 M No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:1 NA
0 N
El Yes
No
❑ Yes
EpNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12/28/04 Continued

R
Facility Number: 8z— 3S
Date of Inspection 9 i3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No C1 NA [__1 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
pillway?:Designed Freeboard (in):
Observed Freeboard (in): �p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
m No
Ir
❑ 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
1� No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
[--INA
❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 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) 1 i s ;- �.. Sae_r
S• a. (o rte +
13. Soil type(s) a o
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 acre determination?[:] Yes
�9 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
,;2 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): I
Reviewer/Inspector Name �� V e,(� Phone: 9/0. Y33, 3j4a
Reviewer/Inspector Signature: Date: i-/ - 240 7
12128/04 Continued

a
Facility Number: 2Z — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ vvUP ❑ 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 ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
4 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
R 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
R 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
P 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

IV
_-- — � Division bf Water Quality .
Facility Number `aZ 3$� 0 Division of Soil and Water Cansen ation
Q Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1'6-09-06 1 Arrival Time- P/SA Departure Time: County: S s Region: ,� n
Farts Name: �/ r /C_'' // c Owner Email:
Owner Name: /w, hue_ _ Phone:
���
Mailing Address: ��� �L� nJ:' e /. � _t!2&Z &V �C �
Physical Address:
Facility Contact: %ULA— A4 4e. Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
= • Longitude: = n 0 t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder JEJ Non -Layer i
❑ Feeder to Finish
Farrow to Wean ZOOO Z o I-)
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars ji
,Other
❑ Other
Dry Poultry
] Layers
] Non -Layers
] Pullets
] Turkeys
] Turkey Poults
] Other
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?
Design Current. -
Cattle Capacity Population
❑ Dairy Cow I I
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Dumber of Structures:
b. Did the discharge reach waters of the State? (1f 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 pan 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 ® No ❑ NA ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
[;K No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[29 No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: S21-3"" Date of Inspection15'O$-O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CS No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes XNo ❑ NA ❑ NE
Stnicture t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): A/
Observed Freeboard (in): 3z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes � No El 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 [@ No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?❑Yes
� No
El NA
El 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
CK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA
❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PK No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
rw
12. Crop type(s) l&r&% % JA - � �-a�,d 5^4 J! -.X ! C"O L Jt.vsr j S 4 -.4 *4
�d.�• l��� sG;•c
13. Soil type(s) _ la-ITO /J GJd a ►��,N!1. _ ,.
-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
C9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[)INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[X No
❑ NA
❑ NE
Reviewer/Ins Pector Name Gak`.' Re�215 ,`;' tx"' Phone:
Reviewer/Inspector Signature: Date: 3__'06
- LO
12128/04 Continued

FacilityNumber: 43Z— Date of Inspection S •d S- D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 09 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [SNo [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [KNo [INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 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
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[} Yes
[WNo
❑ 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
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
® 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
H No
❑ NA
❑ NE
12/28/04

Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit A Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: c3%/1+%a Arrival Time: �.�� Departure Time: County:Region:
Farm Name: i' r ~ rrr. Owner Email:
Owner Name:�*e- Phone: 3`711' 7Y-30
;Nailing Address: _ 6970 G'a � /o ,1.O- H N C
Physical Address: _ F�e �-� tnUaw e r ore, /U
Facilitv Contact:
Title:
Onsite Representative: (. u . fi s
Certified Operator: A lw' , %>/a
Back-up Operator:
Phone No:
Integrator: Ce 1, a - : e
Operator Certification Number:
Back-up Certification number:
Location of Farm: Latitude: = n = I =1 11 Longitude: =0=4
n=4
Design Current Design Current
ne Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ILIRion-Lave[
❑ Feeder to Finish J
Farrow to Wean .2,410,> > o 0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPouits
❑ Other i
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z No
❑ NA
❑ NE
❑Yes
�0No
[:1 NA
El NE
12/28/04 Continued

acilitj Number: +0d — ,35�Date of Inspection 1-371C 70-61
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 (iti): 04,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 [5a No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [jJ 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/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 > 10% or i01bs ❑ 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) r3 er LA r dt r C40S }
wa e_Q WA
l3. Soil type(s) L7lPn� aN, I�.i.cetrG,n-.. Nh� �re+1�.
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
[R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
". r ePhone:Reviewer/Inspector Name
7/
Reviewer/Inspector Signature: Date:
12/28/04 Continued

-FacHO Number: b�—3�-'fT l Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? X1 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections ❑ Monthly and I" Rain Inspections ® Weather Code
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 [0 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Cl No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
FX] NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[V NE
Other Issues
r
07` Q w �rs�.o�\ ofc-GOG pi/ •? 1n 1 e o,>t-'A P(]1 E0.>G i^4y+.AbVG 0.•. dr1�p�3G O�
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28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
® Yes
❑ 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
® 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
❑ 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
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addttio men -aa r Dra 'n s nal ,�"�` , �.�
Go G
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12/28/04

Date of Visit: Time:
Facility Number r��
Q Not Operational 0 Below Threshold
Permitted 0 Certified 1 Conditionally Certified 0 Registered Date Last Operatecd� or Above Threshold: ..... -.— .. .-
Farm Name:_. �r!(iG '! ._...o+ -w► --- _ .. _... __... County:
q
Owner Name: -XC .-- . _. .. W. .... Phone No: `r 1b 30
vtailing Address:
....... ....(r �wh ...._..1T!'_ _ 1:^
Facility Contact:Title:Phone No:
Onsite Representative: t���` S �� w c./: .... Integrator: ... pri
Certified Operator:.— ... M KG -- C . _-------•--......... Operator Certification Num' ber:._.j?52!&._.__----
Location of Farm:
�Ine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [>e--
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 QW"
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 04<0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3
12112103
Structure 6
Continued

Ead ty Number: 5
Date of Inspection pt
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type Fr & 1~G &S`k 0'11 M40,
13. Do the receiving crops differ with those designated in the Certified Animl Waste Managemen Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ll q
❑ Yes
❑ Yes [94fo'00'
❑ Yes 0.K'o
❑ Yes 2<0
❑ Yes 13No
❑ Yes 24
❑ Yes
❑ Yes lzo
❑ Yes M
❑ Yes L 2/o
❑ Yes B<
❑ Yes Io
❑ Yes �❑,� L1
❑ Yes O
❑ Yes Eo
❑ Yes [ No
Copy ❑ Final Notes
r crv1G (kcvidCt `is 4tVt liGo�.e...�. ar'C �fbvider.
N.� 1.0k 9 a &} 4,J re cA s gcrt i i-
1500
-
tS00 ILL VAA Vii e -i ��,�,. .,, oc -
ReviewerAnspector Name
Reviewer/Inspector Signature:
Date:
12/12103 / ) Continued

Faci`ity Number: S;j _ 35q Date of Inspection
R_enuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EWo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Q - Wo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Levo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
940
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q.PK
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�,�
(iet discharge, freeboard problems, over application)
[:1
l<o
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
GKO
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑J4o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dd�Uoita! Comments atid/trr Drawtrigs K:���=�� " - -
`.�2 .v.._.�.r-
Hi
12/12103