310477_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai
II

1.
Date of Visit: Arrival Time: Departure Time: { County: �u,,� Region: (kjl(?z
Farm Name: /W► �Viws. Owner Email:
Owner Name: l` I, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
111111111111111111HUM-1 Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Desigu Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
amDesign Current
Dry I;oul Ca aci P,o
Layers
Daia Heifer
D Cow
Non-Dai
Beef Stocker
Gilts
on-1-Ayers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Uther
Other
Turkeys
Turkey Poults
Other
DischaEges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
ji\3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Ei] o ❑ NA ❑ NE
[:]Yes to ❑ NA ❑ NE
21412015 Continued

ecili!j�,Number: Date of Inspection:
r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 03110 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —ip
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [<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
09-I10
❑ 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
©<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g-<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
[].N'6-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q Ko
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CE]r o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
<o
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
0j,1 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]'Ho
❑ 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
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0,Wo
❑ 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
bj l o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections '❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej<o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
Page 2 of 21412015 Continued

Eracilky umber: [Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [< N ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E],Ko ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] NoF5-<A ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 10 ❑ NA ❑ NE
❑ Yes E "'o ❑ NA ❑ NE
❑ Yes Eq- o ❑ NA ❑ NE
[] Yes [ 90 o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [l <❑ NA ❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative? ❑ Yes [�]'Nf o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? El Yes No ❑ NA ❑ NE
Comments (refer to question° #) Ezpla�n auy;YES answers and/or:any additional recoininendations' or`any q`t er cd;innieots ,
. J; A r , _ d� a t. � %. ,' ",Al
Use drawings of fhb ty. to ,better explain setuationss(use additional pages;as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: '9f 0 M, 7.37
Date: 10� I fY II 7
Page 3 of 3 21412015

Type of visit: td(;ompli ce inspection U Uperation Keview U structure ;valuation U technical Assistance
Reason for Visit: outine O Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: u Departure Time: D County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� ��i/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Q I
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry CapacityCattle C►apacity Pop.
La er Dai Cow
Non -La er Dai Calf
Dai Heifer
Design Current Dr Cow
W n Eo Feeder
ceder to Finish
2'( g
g[)
Farrow to Wean
Farrow to Feeder
Dr, P,oultr Ca aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
F I Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
❑ Yes
1Z<0
❑ NA
❑ NE
Page I of 3
21412015 Continued

4.
Facility Number: IDate of Inspection: �.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes io ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6J'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fNo
❑ 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):
13. Soil Type(s):
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 Ej 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 dNo ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffRo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[D No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
, No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Faeflity Number: - Date of Inspection: z Cv
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Vro ❑ 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 fo - ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No NA [,] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[;] ` o
❑ 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
�o
❑ 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
FINo
❑ 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
C3<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
,0"No
❑ NA
❑ NE
Comments (refer to question;#)Explain any,'.YES'answers,andLor,any additional.recommendations or any other comments
a ..
Use drsiwings of facility to better ex Ins itugtiiins;(use.additiooal ages as necessary).
y
'�a I' / 5 ,, ­0 f I C�" i
se �- o �� k���• ,� i
y
Reviewer/Inspector Name
01,vi� ppt—e//
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � 10
Date: It z
2/4/1015

U
Type of Visit- (?Tompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Grgo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:I--lam Departure Time: �County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Tit
Onsite Representative: e•\ �''�'�"-� A C t� C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: it 0911 y
Certification Number:
Longitude:
Design
Current
Design
Current
D11esign Current
Swine
Capacity
Pup.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
an to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
µ9
D
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,uultr,
C•_a Tacit
l;oP.
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turke Poults
Other
Other
Discharges and Stream Imtuacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ����Noo NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continuer)

Facility Number: - .? Date of Inspection:
VN�Aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �•
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes ❑'l o ❑ 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'l�_o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesEl'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 E5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Flo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3"'N�o ❑ NA E] 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
. Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L/ No
D NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5"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 ErNo ❑ 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 FNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: j - Date of Inspection:
24rDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑' Vo_ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 1A _❑ 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 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?
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 'Co❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
d❑ NA ❑ NE
fNo ❑NA ❑NE
o ❑ NA ❑ NE
Comments (refer to question,#.) Explain any YES answers artd/ortany additi6iia]Eeecommendations or any other comments �'.
Use drawings'of faeilityto:better,expIamsitu:>itinris..(useaaddittonal;pages;'as,necessary):=
C.
P a p-v— l,, rk (hP A s j ,:2 C-1
Reviewer/Inspector Name: --a r (�+�-.�� Phone: q(j 7 j i 7) v V
ReviewerlInspector Signature: Date: 1Y7
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I I X"W] Arrival Time: ® Departure Time: / County: 1L% Region:
Farm Name: 1CC-M_ &AN-S Owner Email:
Owner Name: U4 Rr l) K- U D N S Phone:
Mailing Address: S 14 W H 1 ? >EU t.i Ul L LC— ,%VC o[ <a s I
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Integrator:
��// go I L/
Certified Operator: LAD t.-U R/►'I 1`— V ANS Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
C*urrent
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
01Farrow
Design
ltr. Ca .aci
Layers
rNon-Layers
Current
Dry Cow
Farrow to Feeder
P,o .
Non -Dairy
Beef Stocker
to Finish
Gilts
Beef Feeder
Beef Brood Cow
Boars
Other
Other
III
Turke s
Turkey Poults
10ther
DischarPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes '�O'No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Lj= JDateof Inspection: Q
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): �• 5
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;T No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes IX No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes k
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? 7�C
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 06 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CC j/ LA-] HG4T QE (?- s C 5';�>
13. Soil Type(s): �l.t i Q !:�U ) LL
l4. 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
T� 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 Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" 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 '0 No
❑ NA ❑ NE
0 Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - 4T+ I Date of Inspection: f
1iJ
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes PZNo
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ 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 ages as necessary).
S.Wo6q_-
C A��g�l�;►av aCS14
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gy
Date: 111 (6-o h y
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: fZfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ila-1-13 1 Arrival Time: Departure Time: (j County: 1L1(•ti(J�iYt
Farm Name: VeyL4 Gwni Owner Email: -
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region: k.I..L+!
Onsite Representative: Integrator:
Certified Operator: �L 1 zirw ko K. Ans Certification Number: ol�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Desnt
ign Curre
Swine Capacity...Pp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
f
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J?fNo
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ;2 No
❑ 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 1 of 3 21412011 Continued

4
• Facili Number: -44170 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): CKTa
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZfNo ❑ 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 VTNo ❑ 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 gNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PfNo ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes IdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J�!rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vj No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes iZ No ❑ NA ONE
❑ Yes VrNo ❑ NA ❑ NE
Required Records & Documents
t9. 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VTNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Eacilii"y Number: 1 - wffl IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 7rNo ❑ 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
ZrNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ZNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
4 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
PNo
❑ 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
�o
[] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
7No
❑ NA 0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r;;'No
❑ 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 paus_as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit `A!Zoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time. ® Departure Time: ® County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1 Title:
�
Onsite Representative: i, e_A r 1 `1/VN � �
Certified Operator: Lk)I L L_1 E} M K-• C V 1/YS
Back-up Operator:
Owner Email:
Phone:
Phone No:
Region:
Integrator:
P419 I' 80�1�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = f =46 Longitude: = ° = ' 0 «
Design I I KC_&—urrent
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population C«attle Capacity Population
❑ Wean to Finish I
110 Layer
I ❑ Dairy Cow
❑ Wean to Feeder I
ILI Non -Layer
1 ❑ DaiEX Calf
EK Feeder to Finish Q y
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry ❑ D-ty Cow
❑ Non- Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers ❑ Beef Feeder
❑ Pullets
❑Beef Brood Caw
❑ Boars
❑Tke s
ur
Other
❑ Other
❑Turkey Points
10 Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
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 )(No
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Nu ber: y - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T❑T No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �] No ❑ NA FINE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yesf 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 C—, T ` Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): Coe �� r 1 A vi� L nc(�
-, i )e(z (A)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
a
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.
QWUP ❑Checklists ODesign Q Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tz(No ❑ NA ❑ NE
® Waste Application ❑a Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Wstc Transfers 0 Weather Code
Q Rainfall [:]Stocking 0 Crop Yield r❑ 120 Minute Inspections ❑a Monthly and I" 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 A
No ❑ NA ❑ NE
Page 2 of 3 21417011 Continued

Facilitv Nunriber: ' 2 1 - Date of lnsuection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 'ANo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
UNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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:
❑ Yes 0 No
❑ Yes ONo
❑ Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Dq No ❑ 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,gLI g? Ic N �ue
9)js)'GL 0''
�� G�� 11�N i 1 �- � dl Lj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��Q�jp --T30
Date: ! I
21412011

rype of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I g 7(plij Arrival Time: Departure Time: County: T
Farm Name: �LG/yT & tJ F}AI S Owner Email:
Owner Name: /U 1 L'C, I A rn }�- . Gy RN S Phone: q to— d 18 — SS S 9
Mailing Address: ) R SL] S H11_5 NM '- I (� ec,k(_A U 1 t_C.[ , l yC 9 a s 19
Physical Address:
Facility Contact:
Title: Phone:
Region:
Onsite Representative: �F,/j!r 1/�1/� Integrator:
� a _ .
Certified Operator: �t C.t._l aM � . i,r U� /�: S Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Current
mplllultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P.ouitr, C•_a acit Pao P.
Layers
airy Heifer
[Dry Cow
Non -Da'
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 1317f f
Waste Collection & Treatment
4. I, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
r
a. If yes, is waste level into the structural freeboard? ❑ Yes �E_] No ❑ NA ❑ NE
Structure I 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 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? 9
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManureNudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
l2. Crop Type(s): LA,�) 146A 7- (j S (L S
13. Soil Type(s): I-? LA ra4AV I L.Lr
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
XNo
❑ 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.
QWUP QChecklists 0 Design [-]maps ❑ Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
(]
Waste Application Q Weekly Freeboard Q Waste Analysis [} Soil Analysis
❑ 1Yaste Transfers
❑ Weather Code
[]
Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
Q Sludge Survey
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 Dq No
❑ NA ❑ NE
Page 2 of 3
21412011 Condnued

FaciliNumber: - t`i jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25Pts the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 [� No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7❑� 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
[] Yes �] No
❑ Yes [� No
❑ Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments a
Use drawings of facility to better ex lain situations (use additional pages as necessary).a`
(3ot,4Tl4n� Luc Cr'AC"_')1 a
5 Ll
�� G & Spa �� �x �� u>q 7, a a 1
CO A.
IU jr--3-1 i j C R"
`-�Ilspl 0'9�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 `-Jf�(03a4
Date: l pl l o /a
21412011

1
Division of water Quality
Facility Number 1 0 Division of Soil and Water Conservation
2�� 0 Other Agency
Type of Visit i Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit �outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: ^^Arrival Time: ® Departure Time: County: L� A/ Region:
Farm Name: T i S rr Owner Email:
Owner Name: Lk-)ILuArn � F URN St Phone: Gld-qq<8-555Q
MailingAddress: OJ"1 ,� �__LA y_ Zeu _AUl L-LE, / ve ck
Physical Address:
Facility Contact: y Title:
Onsite Representative: 61Ur —y AiVS
Certified Operator: UJ I (_Q 93 ffi }. f 0 (_4 A) 5
Back-up Operator:
Phone No:
Integrator: ( (�J
Operaior Certification Number: 1 . Du !
Back-up Certification Number:
Location of Farm: Latitude: = o = t =it Longitude: = ° 0 d =
it
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer ::::[:: I Ej
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dai Cow
E]Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: I
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104 Continued

Facility dumber: ' ! —LM I 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
Identifier: _Lac,!QQd
Spillway?: Q
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No
❑ Yes [:]No
Structure 5
❑NA El NE
El NA El NE
Structure 6
❑ Yes f � No ❑ NA ❑ NE
❑ Yes 0 No []NA ❑ 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] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ 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?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) tn� w NCR J(Z�'y-t�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
No ❑ NA
❑ NE
Comments. (refer;to question #): Explain. any YES answers and/ur any `recomri�iendatinns or,any,other�comments
Use drawings of facility'to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name fj{�t; ;'4, l:
Phone: q f tJr!LT39
Reviewer/inspector Signature:
nnJ
Date:
Page 2 of 3 12128104 Continued

a
k
Facility Number: —y Date of Inspection j
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
WUP ❑Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ANo
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ V/ste Transfers ❑/nual Certification
0 Rainfall 0 Stocking E]Crop Yield 0 120 Minute Inspections El Monthly and I" Rain Inspections B Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes X No
❑ NA
❑ 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 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 9 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
*o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
I o/19/iG 0,3n
qlaaljv G.�y
u(�V-I)w p�E_ zd) 9-
C EPE'F; ",N1)L 0q01y
Page 3 of 3 12128104

Type of Visit P Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OLRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: W ffi Arrival Time: ® Departure Time: C] County: ,1v Region:
Farm Name: �,E_14 T L� nV%N Owner Email:
Owner Name: �- I L-ffLll1�m� }T� , +�'N S�} Phone: `"1�ja- or r�-SSSot
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GNT _ Lr U A N_g_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 0 ,1 Longitude: = ° = I 0 `f
Design CUrrent Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
IQ Non -Layer I
I
❑ Dairy Calf
IM Feeder to Finish JINVO
I
❑ Dai Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish El Layers
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turke Puults
El Other ❑ Other I
1
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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)
Z. 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
No
❑ NA
❑ NE
El Yes
No
❑NA
❑NE
12128104 Continued

Facility Number: Is Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: &A600N
Spillway?:
Designed Freeboard (in): �, S
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes SF'l 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 X 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes *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 rW,indow ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) GQ(L.,V (014e_Q (C— 1 U��
13. Soil type(s)
L(-4=—
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VNo El NA El NE
PQNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No El NA ❑NE
YV
0No ❑ NA ❑ NE
Comments (refer to qu�stRon #}, ' Eacplam any YES"answers and/or any,rRecommendat�ons or any other;comments XI
Use drawings of facility to better explain situation s.,{use additional pages as necessary} . �" .i�g}�gsg �?'� tR�r F
7.�.�i'•8?�3�$iffa 5..� 5 11'3 r d k arz. 7 d
- : ¢ e e. Aa k V
CA3 . "
i
g�g,lo� 1• g
Ge-Gc�0(_ `o"l
'T Q1Ms�OCA�TruE
Reviewer/Inspector Name I_
/N : S '�' a';,r Phone:%��(p
Reviewer/Inspector Signature:
Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box, Q WUP ❑ Checklists
0 Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
X No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ VAste Transfers ❑)/nual Certification
0 Rainfall ElStocking E]Crop Yield [] 120 Minute Inspections [] Monthly and 1"
Rain Inspections
0
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
❑ 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?
El Yes
1 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No XNA ❑ 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
0 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
RA No
ElNA
ElNE
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
KNo
❑ 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
0No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Klo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit A Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a Arrival Time: 1 j Departure Time: County: Lf Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: r Title: Phone No:
Onsite Representative:
I /� 7" !� S integrator:
Certified Operator: W I LL. I A IVA V A9y Operator Certification Number: (59H
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I =61 Longitude: 0 o = ` =
Design Current
Design Current
Design C*urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
Feeder to Finish 4b OD
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
Beef Brood Cow
❑El
Turkeys
❑ Turkey Poults
JJIFI Other
Nurn 0 of Structures:
Other
❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
( No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

FAility N"umber:3 I
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
Identifier: LI�I
Spillway?: Q
Designed Freeboard (in): j 1• S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes allo
❑ Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ NE
❑ Yes
)� No
❑ NA
❑ Yes
WNo
El NA
❑ 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 E[No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'f� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
� No [:3 NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E "No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I K.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):
E� e_X6ptV7-1W LF-T_T&X owr o F F1t--tL_ Cjq f5rAj&'T v- �c.T w S c_�bG. Q
er/Inspector Name �} (�! 5 Phone: 4 1der/Inspector
E
Signature: Date: ��
Page 2 of 3 12a8104 Continued

r
r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & hermit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No [3 NA ❑ NE
the appropriate box. [IWUP ❑ Checklists El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
El NA
El 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
�9 No
❑ NA
Cl NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
K No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[4 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
5q NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,ZNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ( No ElNA ❑ 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 ,X[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
Page 3 of 3 12128104

Facility Number 3
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency E
(Type of Visit ?f Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit G routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l i Arrival Time: Departure Time: �lgD County: WGViJ Region:
Farm Name: �//n//� 7✓'�S _ _ Owner Email:
Owner Name: �ryZtLzA"h V4, JS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: /=✓/�/✓�-;
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
0
Latitude:
Phone No:
Integrator:
Operator Certification Number: 1�UT
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
] ] IONon-La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
"
Longitude:
Design Current I
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Dumber 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 ;dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 19 No
❑ NA
❑ NE
❑ Ye�No
❑ NA
❑ NE
12128104
Continued

Facility Number: — 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?
Strut e I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No El NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes>�, No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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 Drifl ❑ Application Outside of Area
S�
12. Crop type(s)
�6X�� , 60�z,IV l.�
❑ NA ❑ NE
❑ NA ❑ NE
13, Soil type(s) Ail -
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? ❑ Ye No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ YeNo ❑ NA ElNE
18. Is there a lack of properly operating waste application equipment? ElYes [/No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other co ments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone
Reviewer/Inspector Signature: Date:
12128104 ` Continued

J
r
Facility Number: Date of Inspection Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �& ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El 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 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No PNA ❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ONo
❑ 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
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
[]NA
ElNE
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
[INA
ElNE
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
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes YNo ❑ NA ❑ NE
12128104

. .
Division of Water Quality
,
Facility Number" Q Division of Soil and Water Conservation
- — ----- 0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit A Routine O Compel-ainnt-OOFollow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1�9, Arrival Time: Departure Time: ffl,145A, L County: Le&e Region:
Farm Name: r✓4Owner Email:
Owner Name: �� -r �/gi� 5 ^_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: T �An1S ��DENA/1! 1 " Integrator: �!L/U1� �f��/Pb„S• . j
r
Certified Operator:— Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 L Longitude: = o =,
= "
Design Current <, ` Design Current,: Design§: "Current
Swine Capacity Population ' ' Wet Poultry, Capacity. Population. Cattle _Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish O
I
Farrow to Wean I
❑ Farrow to Feeder kIk
❑ Farrow to Finish f
Boars
Other:
❑ Other
❑ Layer
❑ Non -Layer I EE
Dry. Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures
F, t
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?
Cl Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 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 l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes YJ No ❑ NA ❑ NE
❑ Yes ,1!'J No ❑ NA ❑ 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 2fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ElNE
(Not applicable to roofed pits dry stacks and/or wet stacks) A
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 ;ZNo ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesoNo ❑ 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
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes 0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes/�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):
AL
Reviewer/inspector Name I Phone: D — 44
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

l
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ g Other
p
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes'ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
/Additional Comments and/or Drawings:
❑ Yes
f�No
❑ NA
❑ NE
El Yes
`❑ No
O NA
❑ NE
❑ Yes
[YNo
❑ NA
❑ NE
❑ Yes
[jNo
❑ NA
El NE
❑ Yes
/XNo
❑ NA
❑ NE
❑ Yes
❑ No
;KNA
❑ NE
❑ Yes
No
A
❑ NA
❑ NE
ElYes
fNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
XNo
El NA
❑ NE y
❑ Yes
YNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: J111101oE Arrival Time: Departure Time: County: 17� Gil`/ Region:.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: mt,)- - CV ASS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 Longitude: = ° ❑ 1 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
12 v
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
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
❑
Daity Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: �J
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
❑N
El Yes
No
❑ NA
❑ NE
❑ Yes
[14
❑ NA
❑ NE
12128104 Continued

Facility Number: 3( — 417 Date of Inspection li o5�
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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &-ao,/
Spillway?:
Designed Freeboard (in): 19, J
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
EIENo 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 El Yes
,��
L-/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EJ 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 ] 0 ]bs ❑ 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) TIC—p—mntlOH (_ 1-1) RESCU MA-TUA ( u GyJS
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes��/o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%[]
Yes
2To
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,
WNo
❑ NA
❑ NE
_ e :. vt V ,
eP,rL4w AJJfN i'LECDn-.0K' Loop Coco,
Reviewer/Ins �
Reviewer/Inspector Name
'
P A2 +t ,ti +a,.: hl
Phone: �0 _) �O�CS
Reviewer/Inspector Signature: Date: i
12128104 Continued

Facility Number: — U Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EI/No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ 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
ET�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
�Ne
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L✓J NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
L] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
L'7 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
Z<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
0 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector tail to discuss review/inspection with an on -site representative?
❑ Yes
0'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9' o
❑ NA
❑ NE
AdditionatComments and/or Drawings: s; ,
12128104

Date of Visit: I Q i 6y Time:
Facility Number
Not O erational C Below Threshold
0 Permitted 13 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ...... it(�.... Cht..................................................................................... County:....... ..........................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
MailingAddress; ............ ....... . ..............................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
OnsiteRepresentative:.... jtf- ....! �_v ft! �$.....................................I......................... Integrator: ..........�.R!(L°............................................
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 4 94
Discharges & Stream Lnpacts
1. Is any discharge observed from any part of the operation? ❑ Yes [(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... l................... ......................... ........ .................................... ................................... ................................... .......
Freeboard (inches): 9.3
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
&No
❑ Yes
[INo
❑ Yes
2/No
Structure 6
12112103 Continued

l~ acility plumber: 31 — y') Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes UIo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes M/0
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 2'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ yes CKO
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes dNo
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes ON-0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (SC-(L"uOA /MA" C_SW
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes eNo
14. a) Does the facility lack adequate acreage for Iand application? ❑ Yes [2qqo
b) Does the facility need a wettable acre determination? ❑ Yes CKo
c) This facility is pended for a wettable acre determination? ❑ Yes E No
15. Does the receiving crop need improvement? ❑ Yes —�o
16. Is there a lack of adequate waste application equipment? ❑ Yes 0io
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes io
liquid level of lagoon or storage pond with no agitation? �/
18. Are there any dead animals not disposed of properly within 24 hours? [IQ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0To
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [ No
Air Quality representative immediately.
-f"t 1' ••7M d:1^}""sd �('Y�.7!M.9N!'"C 'i;' ���1L��].�i�Ml'A'�P }.:,.� '3!i.... i"+�Jt��ryT.�T'"�"Y„:.1'Y>d;�ViIHX 'I`:; SC.wSr4 !-�i:'kl�d •... ••l:D`. i'.vY,�f 1C pry j'"(�§. }It <}3�})'�^ill. ....}
..r,. ...ii7!? •u�;:+!'F.� 'l.>r-'3 rWEF ).;J1 .:+ui?' .t i,. •.;d.`�_.: N 1i.:..Y Mn4,,.,,,:.:x..33fL��FiI»s1i31�E F
Commean� refer to rstran # tYESlaaswers and/or r cammcadatio pr of sr c ®en f '
Use draws of £acfiity to bettetr,explatn sridnabons.,{m�e adit,analfpages as eery) ❑�Fiald Copy ❑ Final Notesi! 1
f a ? `i r.i1: i i -zP1 ,3; i, '7'2 � #t Et,a
A ; � ,. 3; { E d i i? r '
�� �x_ ���"''Y.....it r_rat,_.:3xr'.�r.._. a� .n:',Id�l_o K. r�:
2J) gAvE coP '� Or CCfLTT(—:ZCArC of CoUERRG�e t;ND P60-W''Mr wTnl 2ECvttM SEup OJ17 roV `
ref E w ppa^:=r. . kun PLAce W -TA ZC-C.oRPS,
GET H,y� J�6 G2A�oR T o [,41 E U� L.eueG G AJtx,6_ ate) LAGo n t l . Cori V.pEiC N t W
,AuC,4 . Fag, F AS.t cL 2L6>rkj& q� LCu(---
Reviewer/Inspector Namemla_ ftrl.3 act, ^a aU:i 1; �E� `` _.K .0
Reviewer/Inspector Signature: Date: 10 1-1 10L4
12112103 Continued

FadUtyVumber: l — Date of Inspection b
Required Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss mviewfmspecdon with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
Cr/Yes ❑ No
❑ Yes �o
❑ Yes No
❑ Yes YNO
o
❑ Yes
❑ Yes ZN0
❑ Yes [j`No
❑ Yes (rlo
❑ Yes [(No
❑ Yes CI'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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
12112103

Type of Visit to �Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Yv Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number bate of visit: Time:
10 Not Operational 0 Below Threshold
13Permitted 0 Cert[iriied 0 Conditionally Certified D Registered Date Last Operated Above Threshold:
F
Farm Name: /� V-7 'U/9 � 5 County:
Owner Name: +�r l�7 /' i%40L Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
i
Onsite Representative: F Integrator die/9%L;
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a & 66 Longitude 0 & 46
Wean to Feeder 11 JJJ Layer I I I ILI Dairy
Feeder to Finish7 q p I JLJNon-Layer I I 1 10Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish i otai Design Capacity [
Gilts
Boars.`. Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ La aon Area
Idin� Ponds /Solid Traps I - I ❑ No Liquid Waste Manauement Svstem
Discharges & Stream I_ mnacts
1. Is any discharge observed from any part of the operation? ❑ Yes [�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverseimpactsor potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Freeboard (inches): A OF2 3
05103101 Continuer!

Facility Number: — Datc of inspection
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?
12. Crop type /
13. Do the receiving crops differ with those des' nated in the Certi
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?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes V1 No
❑ Yes �No
❑ Yes C6 No
El Yes �No
❑ Yes ONO
❑ Yes �No
❑ Yes �No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
P No
0
No
f
L4 No
No
❑ Yes ( No
❑ Yes QI No
❑ Yes No
❑ Yes No
❑ Yes No
El yes 11
❑ Yes No
❑ Yes YNo
❑ Yes ONO
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): ' Explaiwany YES nswers and/or any recommeitdiitions or4any.other
p (use additional pages�as necessary),
Field Copy ❑ Fina] Notes a
Use drawrngs-of facility-to.better explain situations.' �_•`�
*{} , wT
� f
/3) L; s rep 5 64,em
­Nco 4Y -T�>t �s i��r�,�TF� Al F F G��A/G)-4-
(fay,l.ZI0955
�G�C
10M n/ I* CC ROZA)�D 7�nI S GriF_,e
Xz
�,�o �- p �j� �= 5 Lam_
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: d
05103101 Continued

"
It

4 , -'
Facility Number: 3/ — Date of .Inspection aj
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [ INo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
/
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�NO
32.
Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
0 Yes
❑ No
Additionalomments an orDrawings:
,:.
611wiffe,
5100

IF
of Vlsit eCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit f"Routine O Complaint Q Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number 3 j
Date of Visit: Z1 Time:
Not Operational Q Below Threshold
13 Permitted 0 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .....................
FarmName: ......................................................................................... ........................... County:.. ..v1** i.!......................................................
OwnerName:............ evij......r✓at,Xf................................................................. Phone No:.......................................................................................
FacilityContact:............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress:.................................................................................................................................................................... .............................. ..........................
)� Onsite Representative: KQ nrr�0.ns .... .............................. Integrator: ll s
............................................................ .............
CertifiedOperator:.....................................................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 " Longitude • d 64
Design ., " Current Design Currents � Desigti'' Current
5 'wine Ca aci Po ulatiorn Poultry, .. Ca aci ..:Po Population Cattle Ca acii ,: Po 'uiation
❑ Wean to Feeder ❑ Layer .EODairy
Feeder to Finish O ❑ Non -Layer Non -Dairy
' ❑ Farrow to Wean
j' ❑ Farrow to Feeder ❑Other F
�..;
❑ Farrow to Finish Total Design, Capacity .
❑ Gilts
❑ Boars Tota1;SSLW
s,
Numberof Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
.;olding Ponds/ Soliil'Traps.
H❑ No Liquid Waste Management System
Diseharmes A Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;3 &O
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes )R!fNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ZNo
c. If discharge is observed, what is the estimated flow in gal/min? h jGI
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes P10
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 'PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )2No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.........................................................................................................................................................................................................
Freeboard (inches): Z G
5100 Continued on back

Facility Number: 71 —07 Date of Inspection I�Tryf� Printed on: 7/21/2000
. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes_;�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Q No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes eNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes gNo
11. Is there evidence of over application? pp❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ YesIoNo
12. Crop type Lo r+'I t(ry1h�4T , Sov�G� RerMv dCi lay, 5,"Q I 4,^0. -, oye,,.S 4
13. Do the receiving crops diffcr with those designatedfin the Certified Animal Waste Management 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?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
1Q yio a(ioos op- ¢et#cjende .were . 6t 0. our this visit; Yoh will xeeeiye titi futt er
.. ctirresnonden... ....
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ YesXNo
❑ Yes ZNo
❑ Yes •,2�No
❑ Yes 2rf,4o
❑ Yes 0ONo
❑ Yes zNo
❑ Yes ONo
❑ Yes �EfNo
❑ Yes ,ErTTo
❑ Yes ; ff No
❑ Yes VNo

Facility Number: / — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,b No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�Q'N0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )allo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -I�No
32. Do the flush tanks lack a submerged FII pipe or a permanenL/temporary cover? ❑ Yes ❑ No
5100

0 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 10 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )6Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1 'ate of 'Visit:
© Permitted © Certified [3 Conditionally Certified ❑ Registered
FarmName: .................!......... E.-Kq.n;5..................... ................................... ....
Owner Name:...........r'..r!..�.�i `�%...�.'1 r .......................................................
Facility Contact:
Mailing Address:
"Title:
Onsite Representative:..../<,'� ,. C V
..............................................................
Certified Operator: ......................................... .
Location of Farm:
(ID Time: I /I S3 I Printed on: 7/21/2000
r Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
lr
County:........ V.0 ! � fx........... ............ ................
Phone No:. .......................
........... .....................:.......I...... Phone No: ..................................................,
.....:................................................................................................ ..........................
Integrator: .... �°r'� r �I� rs
Operator Certification Number:,,,.,..,,,,
OSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • I ]' Longitude �• �� �«
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
f z Q
J2 Z.a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JEJ Dairy
❑ Non -Layer JE3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ! ❑ Subsurface Drains Present ❑ Law -in Area I0 Spray Field Area
Holding Ponds / Solid Traps JCI No Liquid Waste Management System
Discharges & Stream impactr_
1. Is any discharge observed from any part of the operation? ❑ Yes �dNo
Discharge orininatcd at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ;57No
h. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) 0 Yes ;!fNo
c. If dischargc is observed. what is the estimated flow in gal/inin? ;1
d, Does discharge bypass a lagoon system'? (If yes, nolifv DWQ) ❑ Yes 'A No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes rV No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & "Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;KNo
Structurc I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....................................................................................................................................................................................................................
Freeboard (inches): 2
5/00 Continued on back

Fikcility Number: 3r` — Date of Inspection 7o 3 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ trees, severe erosion, ❑ Yes )!jNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
V No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
No
W-.1ste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type Co•» G.lh Se jCAr1S J3err*, U �a ,Sn1q �„ ',,t
13. Do the receiving crops differ with those esignated in the Certified Animal astc Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land applica(ion?
❑ Yes
9 No
b) Does the facility need a wettable acre determination?
❑ Yes
1EI No
c) This facility is pended for a wettable acre determination?
❑ Yes
_W No
15. Does the receiving crop need improvement?
❑ Yes
1f No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W No
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�Z No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
[]Yes
, TNo
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit`?
(ic/ discharge, freeboard problems, over application) ❑ Yes 0 No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 19 No
24. Does facility require a follow-up visit by same agency? ❑ Yes )A No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,9 No
N6•yiolatigns:oi-• dk!flcieucies *r re ngted• doing � bis'visit; • Y;on .Wiii•rebt iye fit fuether
co rxes oridenre: a�ou this visit. .
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):
61-ewa" skovId [JSe all qva I JA6L-, 1,0 4 aek� Goa y_j 40 faW e/- 111;k700h k I&
.`��f pL" f )eve l in oi rne3fatis'. b1,C 41A4-e 1 ►7+tim n e,r 4b freff-g far k/ej
WeAl�c/'� f I col 01 e S) e:�I
,Sure USe ffore✓ bvA4c of "tAlg,15 d'Yl
to 1, s 1-1. Tun e
Reviewer/Inspector Name �7D1Jt �l/rllf '' f J
Reviewer/Inspector Signature: Date: L 5/00

.Facility Number: 31 — ! 1 Date of Inspection () 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ,® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28.. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, []Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, ctc.) ❑ Yes Z No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? gYcs ❑ No
Additjopal,omments an or rawing5;
3/23/99

�`i - Division of Soil and,Water Conservation •Oper,ation Revlew� �,
vision of Soil and, Water Conservation -41
Compliance Inspection
„
,6
Division of Water Quality - Compliance'Irispection `
r
,. k
Other Agency - Operation. Review �; s�� :,. ` `' ' :
- a ,
112 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection Nil 24 hr. (hh:mm)
[3 Permitted tkCertified ❑ Conditionally Certified [] Registered © Not Operational Date Last Operated:
Farm Name Ke64 ...1 ..V.,Gt,m.... ov i. ... County ...............Dqu.r...................... .......................
Owner Name :...... h.Pri'............................... .... �Y4Y1�...........
........... .......................... Phone No: ....��1��....�r.lr�.�...�����..........................
Facility Contact: ....�J .............L.� �1!k ....................... Title: . Phone No: ...................................
Mailing Address: .........�Jr.:/.....lf'kS?....1....1............................................. ..1..✓..e^V1.�r1..
Onsite Representative:.......... . ......... : .................................................. Integrator:......... t......................... I........
CertifiedOperator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............................................ ............... '...1
Latitude • �° �'° Longitude
Design Current , , ' Design.; Current Design Cugent
Swine Capacity Po ulation ;Poultry ; ,, p Ca Capacity n
❑ Wean to Feeder El Layer ❑Dairy
❑ Feeder to Finish JE1 Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other i
❑ Farrow to Finish TotaiDesign Capacity
❑ Gilts,
Boars ,
,�.�� ,i' ota L
Number of Lagoons �, ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holdmg,Poiids / Salid Traps ❑ No Liquid Waste Management System
Discharttes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes x No
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. If discharge is observed, was the conveyance man-made" El[� Yes No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. lf' discharge is observed, what is the estimated flow in gal/min? Al
�{
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ) El Ye �No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ( Yes PNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Strruc�ture 6
Identifier:
Freeboard(inches): ................................... ................................... .................................... .............................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
❑ Yes 1ANO
Continued on back
3/23/99
1

Facility Number: I I— Datc of Inspection
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? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
A No
❑ Yes
jANo
❑ Yes
nA No
❑ Yes
j No
❑ Yes
No
❑ Yes
�No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management 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?
15. Does the receiving crop need improvement?
lb. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Nbo i6Wi6 is'oi- dg#iciencfes -ftre rt�ted• d�lriljg •this:visit: - Y:ou Wiil•rebOW6 iio #;utj�thof ,
corres' oric>tence: about this visit: ' : . . . . . . ' ' .
.. .. ....
❑ Yes XNo
❑ Yes 14 No
❑ Yes P(No
Oyes ❑ No
XYes ❑ No
❑ Yes ®No
❑ Yes ANo
XYes ❑ No
OkYes XNo
❑ Yes FZNo
❑ Yes (KNo
❑ Yes 'qNo
❑ Yes ;<No
❑ Yes f 'No
❑ Yes [X No
Comments (refer to question #): Explain any YES'answers'and/or"any recommendations or anylother comments:" 1
Use drawing y p n situations: (use addrhoriahpages as necessary) _ i
S of facility to better eX lat i iti .
A %9 Ir LZS crS C�r>�1�i0rS GtI/oy✓,
Snse64- Cawt4rvr Ckec-k1i,S`-F r� �1art . l,en LF ol'vriC4- ckf. e_c_+ reel ever csp�%
vri• i,-' WU P. �I,°c,.s w�aa woe a- Cory a� spry r�
GLvcS
sQraU rtc-dfi w
-�reid
r5 �0'" W,*A sA.cTv/VOV. k5�
tg�'g���
'Mt, hAU4s �ra 66"�S 4116 w,
3 Rr nr� Reviewer/Inspector Name
Reviewer/Inspector Signature:( _ Date:
C91t)) 30r-31� 3/23/99

'rf
-Facility Number: (late of .luspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[:]Yes
KNO
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
K No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
02 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
ONo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
tNo
e. rt . ° ri
Additional me omn an raw�ngs '- .. or `
A.
3/23/99

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
September 15, 1999
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
William Evans
Kent Evans
1854 S Hwy I H & 41
Beulaville NC 28518
Farm Number: 31- 477
Dear William Evans:
IT M
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
You are hereby notified that Kent Evans, in accordance with G.S. 143-215.10C, must apply for coverage under an
Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty f601 day, to submit the attached
application and all supporting documentation. In accordance with Chapter 626 of 1995 Session Laws (Regular Session
1996), Section 19(c)(2), any owner or operator who fails to submit an application by the date specified by the
Department'SHALL NOT OPERATE the animal waste system after the specified date. Your application must be
returned. within sixty (60) days of receipt of this letter. Failure to submit the application as required may also subject your
facility to a civil penalty and other enforcement actions for each day the facility is operated following the due date of the
application.
The attached application has been partially completed using information listed in your Animal Waste Management
Plan Certification Form. If any of the general or operation information listed is incorrect please make corrections as noted on
the application before returning the application package. The signed original application, one copy of the signed application,
two copies of a general location map, and two copies of the Certified Animal Waste Management Plan must be returned to
complete the application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
1617Mail Service Center
Raleigh, NC 27699-1617
If you have any questions concerning this letter, please call Susan Cauley at [phone] extension 546 or Brian
Wrenn with the Wilmington Regional Office at [phone].
Sincerely,
a
for Kerr T. Stevens
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encI.)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

0 Division of Soil and Water Conservation ❑ Other Agency n° ,
r 0Division of Water Quality < q� yw�+�
.
o �zR... � u. a...... ,oa.,o 'S.��R �.
Routine 0 Complaint ' 0 Follow-u •af D11' ins ection 0 Follow-up of DSWC review 0 Other
Dale of Inspection Z q
Facility Number 3 i 11 ,
Time of Inspection �124 hr. (hh:mm)
Registered 14 Certified 13 Applied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name; ............. tLwt ....... Ey"% ....r&rrl...,.,..........................................,........I.... County :...... l;1.�kI.vk...................................... .......................
Owner Name: ............ u.&A.i e �`h .... .... E�aKA................................................... Phone No: ..... (q.l.�. t..Z`�.�. Ar`?�i
..........................................
FacilityContact: .......................... Title:................................................................ Phone No:...................................................
Mailing Address:....1$ l...S..... 1J. 11t
...............................
l . .�&.y�.��.�...1.1.............................................. 11518 ..........
............ f...
Onsite Representative:.. t.. ........ V4f ..:................I................................................ Integrator: ...... &— l is
..... ....................
Certified Operator;......:..�.�,.�; !!�.......5.................:. Operator Certification Number,...��...............
............................... ....,..
Location of Farm.-
r.s...e15�:,I....s;� .�....�....:.5�.....t.9lt....i.a..�l...,� .:s......sal....�.f....��.L�.�.�...........................................................................................I.............. A
............ .............................. ..........
Latitude =10= 4 ®" Longitude [=• EHn' =11
1
Design Current. Design Current
aSwuie., Capacity Population `,;Poultry Capacity Population Cattle
❑ Wean to Feeder
® Feeder to Finish
I I- 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ins 1 Holding Ponds 10 Subsurface Drains Present 110 Lagoon Area
❑ No Liquid Waste Management System
Design Current
Capacity Population A`
a
(07,400
❑ Spray field Area
General
1'. Are there any buffers that need maintenance/improvement? ❑ Yes EZ No
2. Is any discharge observed from any part of the operation? ❑ Yes [� No
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gaUmin? N [L
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 1] No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoonstholding ponds) require ❑ Yes El No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certifiedoperator in responsible charge? ❑ Yes ® No
7/25/97
Continued on back

Facility Number: 3{ — L477
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagotons.Holding fonds Flush Pits etc..
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard tft).............. 1,A ............... .............................................
10. is seepage observed from any of the structures? ❑ Yes ® No
11. is erosion, or ativ otlier threats to the integrity of any of the structures observed'?
Cl Yes ® No
12.
Do any of the structures need maintenance/improvement'?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
r
13.
1
Do any of the structures lack adequate minimum or trtaximuni liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
Vj No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type x.»�ll�.D.............. iY�A1�.....G�V�Oi ..............,, .5............GD'r r�
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
6 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
'14 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
M Na
22.
Does record keeping need improvement?
LM Yes
❑ No
For Certiiied_or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 'A Yes [:]No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 1P No
25, Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes [A No
0 No.violations or deficiencies were noted -during' this. visit. Nou.will receive no further
correspondence about this visit'. -
Comments (refer to question #): Explain any YES answers and/or an: recommendations or any -ether comtnetxts ',
C1se &i wiiigs 4facility to better explain situations, (use additional pages as necessary) �1
Iz— 00t4 jtit;(c.�aow 5kovl� b� h-ok3ec}. }
LZ^ klrrz ke A 01 rva_� + sty ac}-i or `3 (vr, skovid be i ,- p�•
z3, sermu ti, re-CO►O _ - `� , b ko � E� } %x� W , l t ;,tiy �w o� Ca) a) 3 gO - Zoo 4
7/25/97
Reviewer/Inspector Name
v
Reviewer/lnspectorSignature: %�,, _ ��_. Ak__ Date: �jL

i� '0'� Division of Soil and Water Conservation ❑Other Agency �r�
y 5 Division of Water Quality
Routine O Com faint O Follo.v-u of C)N' - ins action 0 Follow-up of I)SWC review 0 Other
Date of Inspection 16 -7
Facility Number
Time of Inspection a': 24 hr. (hh:mm)
[] Registered 13 Certified © Applied for Permit Ci Permitted JE3 Not nperatianal Date Last Operated:
FarmName: .......Kuxk... ovo'ns.......... raxk?............................................................... County:...NjOAh............... ......................... .......................
Owner Name: ....... ...;A.1.t&trsU....................................................... Phone No:..i`��A..�.�4.�.-..tea 5..�......................................
Facility Contact: .......... .... .uLu�.S................................. Title: ......... tMbit!' ......................} ........ Phone No: �, /a�..ZS�$`' a` ............
MailingAddress:..... � � ....,... ... N. .... ... ... 9�'..�!............................. ......... &VIAc.YI.-IL....,tA%................................... ... � c ........
Onsite Representative:,....... .................................................................. Integrator:...... .Aga!TIJ.5..........................................................
Certified Operator;............ .�.�. ... ,...t........�rk&I..................................... Operator Certification Number:....................
Location of Farm:
T.a�l!....... �.r ..,......,..........'.....d. r�ie..........3'Yh......e..F......mr....S.i�..i.U:..(.5 ......... ........
....
........ ... .. ..... . .
Latitude ' ' 46 Longitude =' =° "
x 4
Design Current Design ' ,Current Design Currentt'::
;Swine ;;
Capacity` Populsi,an
Poultry Capacity Too ulation Cattle Capacity Populatkdn
❑ Wean to Feeder
1E1 Layer ❑ Dairy
Feeder to Finish
JE1 Non -Layer I I 1 10 Non-Dairy
3;<
❑ Farrow to Wean
� r-
❑ Other
ElFarrow to Feeder
❑ Farrow to Finish
Total Design Capacity;;
❑ Gi]ts
6
E
Boars
Y �y � ��, Total SSLW
�N berof I agoons I Holding Ponds ❑Subsurface Drains Present ❑Lagoon Area
❑ Spray Field Area
} _
Y
❑ Na Liquid Waste Management System
K.
, V,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
• 2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ' ❑ Yes ® No
b, if discharge is observed, did it reach Surface. Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gaVrnin?
.d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �O No
7/25/97 Continued on back

Facility Number: Sj— ?i
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (La oons 11oldin , Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.Identifier: ............................. ............... I ........ .................. ......... I......................... ..............................................................,.......
Freeboard (ft):............ L.l.1................ ...........
10.
Is seepage observed from any of the structures?
❑ Yes
l$No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
p type�ra�r•................................ C1bm......... .............. P
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[$ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
(a No
18.
Does the receiving crop need improvement?
.10 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
J'No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[2 No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[&No
22.
Does record keeping need improvement?
fo Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
fZ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[I No
No.violitions.ar. de'ficiencie's.were; noted during this;visit.-.You:will 'receive.no ftirtlier,:
:. correspondepce about this`visif.
fR' Li --Yr � z 5z y 5 `c. '�i f -' I sax N l 'iN '�
t: tsirrtments(refer to question #} Fxpluin anyYES answers andlor. anyrecom�enrlatians pr any other co�nrtterrts: .i
Use drawi,gs of facthtyto better, onai p�agesnecess icy}' .N, `A r +c
5. C&CC41 w�.4�. S ��� Ifoss S(Jcti+ { 6W.4) riseJ . Wt` ou-i
t$. Qaxmv�a Uro� si-wtJ�� � ;v►.�lrov<f�.
Z2-'F-elks tv\ w�.cic. vV�; T.a on l'lo,,, S6 aJQ ye_.-Cem6- u� �a"' move conven�el,�' receJ✓ti �it�i"�
LO�O�V\C,e
rtcA� z s�Wa Le. k,Iruh Ir`VVWbb—G� A- clj exum er. I1�M., So< «� s�rwj vtcores ikovid be.- v�Joi-,d ► vkAll.
7/25/97
Reviewer/Inspector Name , �►�° ; w'£
Reviewer/Inspector Signature: Elate: p
0

Site Requires Immediate Attention: Nv
Facility No. 31 - 17
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 ^ a-8 , 1995
Time:
Farm Name/Owner: K IL L ay er s
Mailing Address: (2, V • 1 Gox 44 G4,Ja v- 1 e_ . 29 510 —
County: 1� v L 1 c• J
Integrator. L '`}� S Phone: l �-t Lo °r b SS S dt
On Site Representative: Phone:
Physical Address/Location: hf c s i2 1 C7 L
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 40 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: 'ACNEW
Latitude: SdL 1 4- Longitude: 7 It Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)Ye or No Actual Freeboard: -Q.-Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o Was any erosion observed? Yes o�
Is adequate land available for spray? Yes or No Is a cover crop adequate? Yes
--,j Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es o No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No � If Yes, Please Explain.
Does the facility maintain adequate waste management record's (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
u
Signature
cc: Facility Assessment Unit Use Attachments if Needed.