430029_INSPECTIONS_20171231

INSPECTIONS
NUM 111 UAHULINA
Department of Environmental Qual
k-

r•py I`II
Il:!uillilly Y�iy+ 1I�lrulr 1i1 cl :,,,�I.l lIY1#s, l I,,dlt,.,,+r.l:dl�il,7'Hiir, I I,ri r Divi§ion of Water.Resources
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(Type of Visit: QR�mpliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Fallow-uD 0 Referral 0 Emeraency 0 Other 0 Denied Access
Date of Visit: :Arrival Time: Departure Time: r7 County: 6Region:
Farm Name:Owner Email:
Owner Name: J1i1i ,p+-io ' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: >>
Phone:
Integrator: l
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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$w nC., 1� II I, 14 Ca aci 11� ' I + +i3 Wet Poultiy Capacity I dPop Cattle Capacity ; Pap.
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Wean to Finish' La er: Dairy Cow
4 " Wean to Feeder Nan -La er ,p, DairyCalf '
Feeder to Finish �(� jYllu''f t'p "' I'>Mu `+ bmyS w a .
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, "hnlr�l(at r �b4iw'd
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I Farrow to Finish La ers Beef Stocker
.,
�i Gilts prl
� Non -Layers YIiI. Beef Feeder 1 t•
olll Boars"{{{{{{' Pul lets { '' Beef Brood Cow
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Other 10ther I
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Discharees and Stream Impacts
1. is any discharge observed From any part of the operation? [] Yes] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
a. Was the conveyance man-made? ❑ Yes ❑ No [ NA ❑ NE
b. Did the discharge'reach waters of the State? (if yes, notify DWR) ❑ 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 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
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _� 21-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): zs
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?
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?
0 Yes
V1 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
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
0
❑ 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 j ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V t, W �lf _ram
13. Soil Type(s): (j R 15 * 15h .jf�
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? UP
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
7�
❑ 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.
❑ WU P []Checklists [] Design [] Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 7 No ❑ NA [] NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ctiom C
714,019
�E 24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
[] NA ❑ NE
I
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-com piiance:
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
E] NA NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EN No
0 NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
[] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
No
[] NA [] NE
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.
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Reviewer/Inspector Name: hk?2F
Reviewer/Inspector Signature:
Phone:
Date: AY9��/0
21412015
Page 3 of 3

g l zrl t-7
�� Divi"lion of -Water Resources —��
Facility Number i� - ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L SC Departure Time: � County: A' Region: F1.20
Farm Name: !c7 17? S
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
� n
Facility Contact: /O /��4-f Title: _ Phone:
Onsite Representative: 10i W ,F'f i Q Integrator: 1'`Q.,S 4
Certified Operator: N Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
inish
7Feeder
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
eeder
Non -La -Layer
EE]
Dairy Calf
Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr, P,nultr, Ca aci P,o
La ers
Non-DaIry
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
irkey 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 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
❑ Yes No
❑ Yes No
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Faciltby Number: Z13 -704 113ate of Inspection: q $ 7
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):
N
Observed Freeboard (in): ,3 2 7
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?
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
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
[] NE
maintenance or improvement?
Waste Al2plication
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 [N 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types}: 1'Y�-UQLt 92v72 S� • ►n %%Lui�
13. Soil Type(s): co 6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q§ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes T No ❑ NA ❑ NE
the appropriate box. T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 01 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Q0 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

' Facilfly Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[a No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
YW No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
�5430629
�3 0° 2`
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [�j No ❑ NA ❑ NE
[]Yes [P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes © No
❑ Yes TT®No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: wo-- y33 -3 3cv
Date: q 1 47
21412015

1,115. �- a I'z►^'� z- �
'V 6 Division of Water Resources
Facility Number I q3 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: I Orla0a,Departure Time: G%. County: {Z-A��Y1�Region:
r
Farm Name:
Owner Name: ar" { Ltit��;Ab►�. �I��`��-tr
Mailing Address:
Physical Address
Owner Email:
Phone:
Facility Contact: -T—O ty, //Title: Phone,
Onsite Representative: -Tor l Integrator:�r'�S
Certified Operator: Certification Number:
Back-up Operator: k) I ( I► Q.w �tiT Certification Number:
Location of Farm: Latitude:
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 Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
pullets
Turkeys
Turkey Poultr
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [� NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Cp No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No [ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SO 3r'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
F
❑ NA
❑ N E
(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
0 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
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'? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ❑ NA ❑ NE
maintenance or improvement? T
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):
13. Soil Type(s): 6vV) t 8 r,
5^ .
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage 1br land application'?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
7 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
® No
[] NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes 1� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

acili Number: At Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No
the appropriate box(cs) 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 ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #)c Explain any YES answers "and/or any additionalrecommendations or any other comments:
Use drawings of facility'to better'explain situations (use additional pages as necessary). .
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
AWE 143or2-a:Alcrac�0�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
. Page 3 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[]Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Phone: g10:y_ -33a0
Date:
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j2�J� ^Arrival Time: Departure Time: County: )tFTT_ Region: FAC
Farm Name: �`� rit.✓wL .__... ,.,.
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: `�� &cA� Title: Phone:
Onsite Representative: I pW, '. Wr V 1i'dYm irJu-� Integrator: Pres_ 1:;q "S
Certified Operator: j Certification Number: 176'Z(Q
Back-up Operator: W{11j iarn ��� Certification Number: '2-o925'
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 11
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
35V 7,9317
Dairy Heifer
Design Current
Dr P,oultr, Ca acit P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
, :"
er
rkePoults
LOtherrke ser.
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 10No ❑NA ❑NE
❑ Yes
❑ No
NA
❑ NE
❑Yes
No
®NA
❑NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
rZNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility ber: N - Date of Inspection: R
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ';b N .39 k
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 S] 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 ® 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 �D No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5A 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): rl'-nVj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ R 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 ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
Re uired 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 f 7� No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JS No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facilit ber: a 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® 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 [K No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
A-w5 z13 0o zq - Y4beN
Reviewer/Inspector Name: Le� IV 1Z P*
Reviewer/Inspector Signature: TALI-419
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [�jNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes X) No ❑ NA ❑ NE
❑ Yes [Y'No ❑ NA ❑ NE
❑ Yes
[�j No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Phone:
Date: 2 �rt2
21412015

Reason for Visit: 0 Routine O Complaint O Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 107. th Departure Time: County: �R-7T_Region: --'
Farm Name: �jLC.`" f PX Far r'$
1-1 j I
Owner Name: 0 �1 s �/' t 11 Q fF r� k i`4r_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: To". 0"44-y- Title: Phone:
Onsite Representative: Integrator: ��5%.r►•� s
Certified Operator: Certification Number: 176
Back-up Operator: Certification Number:
Location of Form:
Latitude:
Longitude:
Qeslgn Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Paultty Capacity Prep.
Layer
Design Current
Cattle Capacity Pap.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
7 SD
,i
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I) . F,o,ultr, Ca acit A,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. 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 0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
a What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Rg No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

F cili Number: - Z* Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? [] Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
[] No � NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
�// r .7
Observed Freeboard (in): J O �J I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IN No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify 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
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 P] 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): &-V1►'111J0L M41`1 , 3M .
13. Soil T e s : v
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
FX] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
171 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M) No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ' No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili ; N mber: - Date of Inspection: 17
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.
Q Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes 1p No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[]Yes No
❑ 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 eages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014"

8ws
14
�Q 0ivisien of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: E Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: GEa. Region:
Farm Name: t✓` AAA lw'.r
Owner Name: ilh1K1T l cj � ram..,,.,,.- ,.,-.
Mailing Address:
Physical Address:
Facility Contact: I O !!6. &Az"? Title:
Onsite Representative: t {
Certified Operator: ff
Owner Email:
Phone:
Phone:
Integrator: &A!:U
Certification Number: 17 V
Back-up Operator: Certification Number:
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
Latitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
"Layer
Non -La er
Other
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes Fj'No
❑ Yes El"No
LJ'A ❑ NE
[117q-A ❑ NE
[ 'NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F49' o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []PK ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g ��
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
®'Na ❑ 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
[jNo�❑ 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
M 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 ❑' oo ❑ 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 [3Application Outside of Approved Area
en
12. Crop TYPe(s): �. �J �!
13. Soil Type(s): W
14. Do the receiving crops differ from those designated Ythe CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CKa
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[8 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2-1q'o__
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[55
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-N-o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2I . Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L.J ""'
❑ 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
, Vo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

i
Faeilit N4 mber: Date of -Inspection: bw (�
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 dNo ❑ 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 r�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [� No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
1
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes ['J No
❑ NA © NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes F2�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EVo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use`drarvings of facility'to better explain situations (use additional pages as necessary).
&J (L V&+,o L I \ r-
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
�6,(113
Phone 8r
Date:
21412 11

T rt
Q4.1%vision of Water Quality
Facility Number O.Division of Soil and Water Conservation
G^ 0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up 6 Referral Q Emergency Q Other 0 Denied Access
Date of Visit.:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
�` ��%✓ Owner Email:
�. I rf A'7 T 1 f
Facility Contact: _h It Title:
Onsite Representativ g
Certified Operator: t
Back-up Operator: __ tt
Location of Farm:
1. ;Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Integrator:
Phone:
PV-'e4Z;;_;
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
Layer
Non -la er
D
Pullets
Other
Design Current
Discharges and 5tream Impact
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
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes UKo ❑ NA ❑ NE
❑ 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
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Y
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ml o
❑ NA
❑ NE
of the State other than from a discharge? rl
Page I of 3
21412011 Continued

r
(Fac11151 Number: Date of Inspection: /0 I=U--
Waste Collecdon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&Ko [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes LZjXo0 ❑ 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 lDoNo ❑ 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 ®Xo ❑ 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 Q,?Qo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ET'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D4o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> i0%or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /.e cS 10
(p 13. Soil Type(s): i t"4 l�
14. Do the receiving crops differ from those designatlu in the CAWMP? ❑ Yes FC�&o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []Wo ❑ NA ❑ NE
16. Did the facility fail to severe and/or operate per the irrigation design or wettable ❑ Yes [E�<o ❑ 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 [R<o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Vo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r.—LXo ❑ 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 U3,40
❑ Waste Application ❑ Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspections
22, Did the facility fail to install and maintain a rain }gauge? ❑ Yes Mio
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes i<o
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

W
on
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g Ko' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ P?6___ ❑ 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 GDAM ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a "o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24•hours and/or document
❑ Yes
k No
[a NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Fga<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
[ZKo❑
NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[a-Ko
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErN
❑ NA ❑ NE
Comments (refer to question #): )tJxplain 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).
Reviewer/inspector Name:1
Reviewer/Inspector Signature:
Page 3 of 3
PhonBj ffq'I` " 3
Dace: S
21412011

q!gI1.)-
q
Type or visit: 0 Compliance inspection Q Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 04koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1l
Date of Visit: a I ^ I Arrival Time: Departure Timer County: HaRnf#'
Farm Name: ZLJ4 /£ g FOAM S Owner Email:
Owner Name: I jzI r .x A m T . ')'3u., le &0 Phone:
Mailing Address:
Physical Address:
Facility Contact: t.)z 11z A PI T , Lit Title: Q t.Srj r A Phone:
Onsite Representative: J _ T_11r a.V4-t a, 341 t tl Integrator: N F R-VAc q
Certified Operator: U211:19kna,-,.A 1 e K,___
Back-up Operator:
Location of Farm:
Region: pzo
Certification Number: 'a Ut jd I
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capac€ty 1'op. Cattle
Layer Dairy Cow
Design
Capacity
C►urrcnt
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
'73";D
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
IDesign Current Dry Cow
Drr P,-ultr, Ce acit P,o Nan-Dal
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turkeys
Turkei Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes [R(No ❑ NA ❑ NE
❑ Yes
[] No
aNA
❑ NE
❑ Yes
[:]No
EfNA
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E� No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility N=ber: LA2) - a Date of Inspection: '2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfVo
a. If yes, is waste level into the structural freeboard? ❑ Yes QNo
❑ NA ❑ NE
❑NA [3 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ 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 M'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 [LrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2-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 C!fNo
❑ NA
❑ NE '
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 5:1"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 6 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): Z M(\To\VD-A V\i%
13. Soil Type(s): Q5 Cb
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [v]' No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[V]'No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[I No
❑ NA
❑ NE
Reauired 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
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 8 No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 15a NA ❑ NE
Page 2 of 3 21412011 Continued

Fatilit -Number: 4 Date of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r— to [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [j No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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 ,�] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
UNo
[] 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
[3�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[]]/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[:KVo
❑ NA
❑ NE
❑ Applicalion Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3'/No
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
© No
❑ NA
❑ NE
34. Does the facility require a follow -tip visit by the same agency?
❑ Yes
[vrNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answersandlor.uny additional recommendations or any other comments
Use.drawings of facility'to b&ter'explain situations (use"additianal.pages as necessary): :
Reviewer/inspector Name: C\ p`� , oa`,S Y_,y0 S Phone: 21030 LA5 J
G
Reviewer/Inspector Signature: Date: N a 1 a
Page 3 of 3 21412011

(.*'**Division of Water Quality
facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: UrMo7liance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: e Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 00 Departure Time: t ounty: — Region: ice_
Farm Name: ��� pyq'—!)yls Owner Email:
OwnerName: /-„fir Phone:
Mailing Address:
Physical Address:
Facility Contact: zUj ��QrN.. .;�6—"t-"- Title: 0-C-A -W— Phone:
i
Onsite Representative: 6L)t jl Q'y„ , per` Integrator: Ilaf
Certified Operator: f.1AJ111j 4 Certification Number:
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
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
RI Layer
pry Younry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes ❑ No
[:]Yes I?No
[:]Yes lid40
0-11A ❑ NE
9'KA ❑ NE
[9 A
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Fla ciIit Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q''io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ta "o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d—
Spillway?:
Designed Freeboard (in): 1�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes To ❑ 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 2<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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ego< ❑ 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 io ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo [] NA 0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ IVo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [Vo ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes
[/] No
❑ NA
❑ NE
[:]Yes
E!fNo
❑ NA
❑ NE
[—]Yes
[ Rio
❑ NA
❑ NE
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
[�146
❑ 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
t.'go
❑ 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
[�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[j4A
❑ NE
Page 2 of 3 21412011 Continued

F%cility Nudtber: Jf. - ad % 1Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes G21<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes '❑ No ❑ NA 5�, E
Other Issues �,,�1V!�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ L� Yes e ❑ 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
�io
❑ 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
[3 Yes
gl o
❑ 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
B<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a<o
❑ NA
❑ 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 pagesas necessary).
a '. A`t �' t .1-1
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: g2& —4 2
Date: 16A &!�//
21412011

`"
Division of Water Quality
Facility Number Division of Soil and Water Conservation
O Other Agency
Design
}
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
Date of Visit: M Q j Arrival Time: t a Departure Time: Qpn County: Region: F-go
Farm Name: �►-� etr Fa, ,S Owner Email:
Owner Name: _ t/" t I I+CtJM L4-+ e4l - - _ Phone: 9)0_tW3-ab/0
Mailing Address:
Physical Address:
�j• f t 1
Facility Contact: "� �f lam B te Title:
Onsitc Representative: it
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Eres4,q,;,_P
Phone No: --Integrator: J'�yr� , S
Operator Certification Number: AoyD-(
Back-up Certification Number:
Latitude: = o = 1 = {! Longitude: 0 0 = 6 0 «
Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Other
❑ Other
Dry Poultry
ElLayers
ElNon-La ers
ElPullets
❑ Turke s
El Turkey Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication 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
El Dairy Cow
❑ Daig Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 0
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?
El Yes � No ❑ NA [INE
❑ Yes
ElNo
[X NA
ElNE
❑ Yes
ElNo
NA
ElNE
[IYes
❑ No
JgNA
❑ NE
❑ Yes
No
❑ NA
ElNE
❑ Yes
No
ElNA
[INE
Page 1 of 3 12128104 Continued

Facility Number: L�- _ Date of Inspection
W ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes �O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No F 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JP 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 F� No ❑ NA ❑ NE
maintenancehmprovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 59 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 oIguiv
le Crop mdo ❑ Ev' f Wind Drift ❑rApplication
1Outside of Area
12, Crop type(s)A.5, . ��'1
13, Soil type(s) 6: al; i is n 8 `—`' f i "r\ IS" 6a" 'S
r
14. Do the receiving crops differ from those designated in the CA WM P?
❑ 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
[3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rVo
❑ NA
❑ NE
i'3'�T.'�3Z�-,�'e�#� - ,s3b
Comments (refer to uesfion #) Ex lain any YES Answer's and/or an recommendations or an other comments'
x. .,q..; q_.rky�.I7 .o, "11 X''^"E'7', y,'; it n a�x'Yi �w.; �,,sy�� -: v,. +,fir
:Uic drawtrigs of facility to. licttcrexplain situations.i(usea'dditionttl�pages as n.ecessary):�
'AA .� k�! tX' _.. ,Y, � ..k � V ,I�4 Al
(&4r
Fyc_tt kl�_ "_C� fl�9
..$.
Reviewer/ins ector Name s r t ' �O 330�
P :, �x.:.A.�>{o ,'sa Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 5'
Renuired 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 09 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,E� 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?
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?
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
❑ No
J9 NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes JE No ❑ NA ❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
Page 3 of 3 12128104

I vIV9 %�rvs
Division of Water Quality
Facility Number Division of Soil and Water Conservation
O bther Agency
Type of Visit 15� Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: Q ; Departure Time: �g,3Q County: Region: _FM-- -_
Farm Name: _pyiter _FQIMs p 1 Owner Email:
Owner Name: �r I �� i' 4`1 I pL+ Phone:
Mailing Address:
Physical Address: Q b
Facility Contact: "-mob$±„ 84It�^_Title: Co—o "'n�' Phone No: IRC13-53�7
Onsite Representative: Ro W 0*1ff Integrator: R'Osiaa'e_
Certified Operator: Operator Certification Number: aogo-7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ 1 = u Longitude: = ° = 1 =
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 DesignCurrent
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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?
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures.:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C.13'No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

• Facility Number: 3 — cI Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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): 1 Q
Observed Freeboard (in): at$ 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
1,;JNo
❑ 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
UNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? N"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
0 No
❑ NA ❑ N I:
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. [I Yes
�No
[I NA El NE
El Excessive Ponding El Hydraulic Overload [I Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or I01bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) Q0al aI 86mydaL. Ma,) ;l.Grn WL11)'1) ; SG 01
13, Soil type(s) 6'11�p_JS Dj&t %r LS E- �711 J_ `�Vam
J /
14. Do the receiving crops differ from tho. c designated in the CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
f5�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C'No
❑ NA
❑ NE
IComments (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):
Reviewer/Inspector Name 20t°tV SC.H10FICZ !Phone:
Reviewer/inspector Signature: Date: H&M I,i'
12128104 Continued

Facility Number: Date of Inspection10.31/1104
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 F�-No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JNWYes J;�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ((❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections N(Molly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ER'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
aNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
fp'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
[RNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
RNo
❑ 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
(R 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IRNo
❑ NA
❑ NE
AdditionalComn>entsand/or Drawings;:
S� L4J00n mark-•s 1^600lr� , N1av�a0cl? -�'hral�h layolgl ��lfl�, Not y�ef paj17W t *FV_,
A,
s weekigaer j6 1 q� y oai read tti r-h i'llf- Robl�i- wo r Jo ai e , Needs � f -a b f rye acL "let ,
o.�-ed. wH'l'�,� r2c�cCr.
ar, Croiields need- bhor
Sd i full Oat` lei
'r ��,
�. �l�dJ�
Fleaja ma 1 IA. 0fn +a
D EW R_ _ A P
aNr G em s+ CwNe. 71 y
Fare+p i lle, }vc agao)
Vff% wf-lI mqh'faj�ej 'FA/n7 excepfasnA ak 1,P,
J
I
Page 3 of 3 12128104

Facility No. y Farm Name
Permit COC
Date 3 0�
OIC_ NPDES (Rainbreaker PLAT ' Annual Cert )
FB Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
OW
p-
-����
Design Width
ry
Ii
�!e1.a'4� a� a�aoaq
Soil Test Date '� Crop Yield
pH Fields Wettable Acres f
Lime Needed 0 Lgaom WUP ✓
Lime Applied Weekly Freeboard
Cu _✓Zn ✓ rnb-+� Rainfall >1"
Needs P I9 941111 1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
DeqP box or incinerator
11MAv aT_51vk8j
Atc—*6_4
WasteAsnilyiLisb—ate
Pull/Field
Pull/Field
soil
Crop
RYE
PAN
Window------_
__. Max Rate
Max amt
C S
4 Il o
Is
5
Verify PHONE NUMBERS and affiliations uw bak1 kf-� or(&"1
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

t Division of Water Quality
tr Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit JkRoutine O Complaint a Follow up Q Referral 0 Emergency O Other ❑ Denied Access
Date of Visit, ot5 i7 Arrival Time: a Departure Time: L County:
Farm Name: f ., fuT U F_aiMS Owner Email:
W Owner Name: ; IL )oLm l � bq_r, i (L ��A't eL Phone: _
Mailing Address:
Region:
Physical Address: __. _. I�.i�r�,T
[. ((_. , U
Facility Contact: l� t `� 1� LV Title: Phone No:
Onsite Representative r U.► Integrator: --,
Certified Operator: �� Operator Certification Number: Q V'+O
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Reeder to Finish'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [7o = I ❑41 Longitude: = o = i ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I J❑ La er
[_1 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharees & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ®1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
❑ Yes'RNo ❑ NA ❑ NE
❑ Yes
❑ No
IFNA
❑ NE
❑ Yes
❑ No
]$ NA
❑ NE
09 NA
❑ NE
[] Yes
❑ No
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

Facility Number: —z
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 1 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 XNo
❑ Yes 0 No
Structure 5
❑NA ❑NE
[DNA ❑NE
Structure 6
❑ Yes )�,No ❑ NA ❑ NE
❑ Yes 59,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 "KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes `71 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) FIL
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 *o ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � M UJA _L } f_t ] , � (`ri1- iV-
13.
Soil type(s) GOL,---
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 'fi<No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes )4 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑Yes%No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
[]Yes L 4o
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other<commen"
Use drawings of facility to better explain situations.,Ose,gdditional pages as_ ceessary}: ,
ts
T
Reviewer/Inspector Name
r
Phone:
Reviewer/Inspector Signatur a
Date:
�j
Page 2 of 3 12128104 Continued

Facility Number: T73-77,71 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes DQNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 ;�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No 74,NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JK-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[:]Yes
"gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No 'IONA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�lo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'KNo
❑ 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
'KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[NNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Lh co ve.i' So
CSJrrt os�w f- 4j.aA 0"Y11 mo'[s ( 4Q'ra_ 0nczc l
b r-,PE Z�$. V
�
► PS Cjom
- V'Z com rn ed C[arx eiz l o �L 4
Page 3 of 3 12128104

Facility No. Time In Time Out Date
Farm Name ��4`ku V-GLyry Integrator Rt
Owner W ' ���4��-� q is-v Site Rep u-�� ✓
Operator Y2,oL_,_,j No. a�`?
Back-up No.
COC Circle: General or N P D E S
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
- inish
Farrow - Finish
- LLD —-1
,7D
Gilts I Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test b_ ✓ Wettable Acres _
Weekly Freeboard t� Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
•2.3 z .
Observed
Calibration/GPM
Waste Transfers
Rain Breaker '
PLAT ---
1-in Inspections i
Date Nitrogen (N)
14Q 3 �
b� v
Pull/Field
Soil
Crop
Pan
Window
F
Lan
Hills-
r
n
_
C-Ir
0

(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 4D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j Arrival Time: Departure Time: County:
Farm Name: 1U ms Owner Email:
Owner Name: JX) �l ,p`ry)_" * 4 I R U ! Phone: _
Mailing Address:
Physical Address:
Facility Contact: P&�-[4 _& �4r' Title: O W�
Onsite Representativv'e��:
2o6j'A !JU4JOX
Certified Operator: t�iCZ11. - L
� I
Back-up Operator: 1A� , 11 � �1 1A1 lex
Location of Farm:
DDII-TO c.\ 'r<-d-
Latitude: n 0
Phone
Integrator: I"' r V-
Region:
V
Operator Certification Number:
`� () 40
�1
Back-up Certification Number:
Longitude: = ° =' =
Swine
Design
Capacity
Current Design C*urrent Design
Population Wet Paultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
JEI Layer
10 Non -Layer I
1
❑ Daia Cow
❑ Daia Calf
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
1 '7 ❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
El Layers
ElBeef Stocker
❑Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Turkeys ElBeef Brood Cow
❑ Turkey Poults
1 10 Other Number of Structures:
❑ Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 0 NA
ElNE
❑ Yes
❑ No ANA
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
No ❑ NA
❑ NE,
❑ Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility plumber: 7j — OZ
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): cf
Observed Freeboard (in): �t-
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 ❑ NA ❑ NE
❑ Yes ❑ No �NA ❑ NE
Structure 5 Structure 6
❑ Yes [X No ❑ NA ❑ NE
❑ Yes PqNo ❑ 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 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) � ni l.L, A4 , Qty r1T� Car I � fS �-�
13. Soil type(s) G CX_ )1'�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes )9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V`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 [XNo ❑ NA ❑ NE
Comments (refer to question #): 'Explain any YES answers and/or any recommendations or any-other.comm fits {.`
Use drawings of facility to.better explain situations..(use additional pages"a's necessary):
Reviewer/Inspector Name I QsTt . L4N? I Phone. LO 33 33Ga
II
Reviewer/Inspector Signature: Date:
Page 2 of3 12128104 Continued

scility Number: —C3 Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Clo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
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
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t4a
❑ NA
El NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
40 No
❑ NA
[:INE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
A] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Iv e use— r)zkz Cf l 6 rw.�d m-�es �c r c d
?u.t r, r s- exw-,n 4-'S 0.pe-lr i ra-f tcs1 6-1e .
o U ULVN) n ejv n-�s s� btJJ (yn 4k -t c�-W (P �&xrnv,&
N 07 to —on ?-Ae— loflcjo_�Lsk_ vl:baz n"'Qf SR_f_GW
S.rr), L 4 f 0.1,n T�w►� f�, = r! j
�U�r�O i ► # V�p
C_,4,tQ1l�h
Page 3 of 3 12128104

t
!ability No. { Time In 1
Time Out Date a 0
,�
Farm Name �'�,3 4 6_. � Qj MS I Integrator
Owner _twh kot�x r GV U��- Site Rep• g A
--operator V,i�"� - No. d '1��
Back-up 4 Wi 1 No.
COC
Circle: General or NPDES
Design
Current
Design
Current
Wean -- Feed
Farrow — Feed
Farrow — Finish
eed 7 Finis
50
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design r Observed o� � Jr
Sludge Survey '� Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge Rain Breaker J[
Soil Test PLAT Wettable Acres v
Weekly Freeboard Daily Rainfall--`" 1-in Inspections ✓ ,, `�
Spray/Freeboard Drop
Weather Codes 120 min Inspections l 0
Waste Analysis:
Date Nitrogen N) Date Nitrogen (N)
lag
Pull/Field Soil Crop Pan Window
r CC
cz
0 {6U - AVod
v

Type of Visit ompliance 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 ❑ Dented Access
Date of Visit: /Y_=D Arrival Time: �'r3 b Departure Time: 'tom County: ✓j1v Region:
Farm Name: (,��� &Zrm_� p 1 Owner Email:
Owner Name: 1 �-w.Y !1_o��-Y_ _ �Y�_ Phan.:
Mailing Address:
Physical Address
Facility Contact: ,/ )t4 Lu. 6-,/"—Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: __ zi�'��,�,� Operator Certification Number: ,OQ L/ 02
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
Back-up Certification Number:
Latitude: 0 0 = I Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
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
❑
Dairy Calf
❑
Dairy Fleifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stacker
❑
Beef Feeder
❑
Beef Brood Cow
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)?
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
[a No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
R No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 41
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:�-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):r
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 LgNo ❑ 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 [A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 12 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
INo
El NA
El 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
R,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Lj[No
❑ NA
❑ NE
Reviewer/inspector Name777
Phone:
Reviewer/inspector Signature:
Date:
iP
12128104
Continued

t
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El 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 [VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5� 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
[34No
❑ 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
j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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 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
RNo
❑ 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
rR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[R No
❑ NA
❑ NE
sa/YdLoriAdditonalCoii
.raw
ItleUJ G ��i b /-ct�i D"L. On �/p �,c r ��%� vim•
C� �P 1�17
eeL Gum /9�2
.Sol.�od S-e4-- 17 FG.vLL v---
12/2&104

Ii:.b153.11ib:;p n-•..n:�'ty!"n"L:I&'�"3��riMd:'�Y;Cli'r:Li��'.i�3�i4:�1?iL :.��. � -.-A -" .: �' , _ ... z- . ,!'.'�' ... c...:' a... . _, r ....... ._ . _ i l
Type of Visit ® Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint 0 Follow up Q Emergency Notification C) Other ❑ Denied Access
Facility' umber Date of Visit: O� Time; n
Not O erational Below Threshold
® Permitted ® Certified ❑ Conditionaliv Certified Q Registered Date Last Operated or Above Threshold:
Farm Tame: 2LL kA_r 1�;5,i-m_ _ - - Count':. N2GV-,,_ -- L
OwnerName: IA). (L'&Ln T. -1- (Zz6gr4-- R;, fla4 r- Phone No: it 0/ 1 J3.: .m
Mailing Address: 2,31,- Pn a e4 �rG,r'rri- J&OC A ' 2�S 4G
Facility Contact: Ao kerL aL- Title: Phone No:
Onsite Representative: LbeLL &&LIgr integrator: �oe
Certified Operator: &-j6e_"�- 1aa±LaL Operator Certification number: aa&of
Location of Farm:
® Swine ❑ Poultry ❑ Cattle [:1 Horse Latitude �• �4 u Longitude 0
Design Current Design Current Design Current
Swine Ca acity Po uladon Poultry Caliacitv Population Cattle . Capacity Population
Wean to Feeder 10 Laver ❑ Dairy
Feeder to Finish ` o IFJ Non -Layer I. I❑Non-Dain
Farrow to Wean
Fafrow- to Feeder Other
Farrow' to Finish Total Design Capacity
Gilts
Boars Total SSLW
Number of Lagoons — L _ 1 ❑ Subsurface Drains Prese'n't—JID La oon Area 10 Spray' Field Area
.Holding Ponds / Solid Traps !� ;� © No Liquid Waste Management System
Discharges S $tream Ilingacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 Colitgtion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ®spillway 6-t t4�VY+ l a� �j
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): S 3 S
05103101
❑ Yes 5a No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
91 No
❑ Yes
[25NO
❑ Yes
ELNo
Structure 6
Continued

Facility Number: 4 3 — Date of Inspection 0
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 or 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?
❑ Yes [KNo
❑ Yes UR No
❑ Yes [RNo
❑Yes L 0 No
[1 Yes P,No
❑ Yes MNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [jNo
12. Crop type 0 e rVIp,I d .a . -d- 'q ,-.A , YV-4 "a P" I',. � cr hn01
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes Q No
16, Is there a lack of adequate waste application equipment? ❑ Yes [0 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
MNo
19.
Does the facility fail to have all components of the Certified Animal Waste Management Alan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
f No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[R No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[a No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
0 No violations or deficiencies were noted during this visit. You will receive no further Correspondence about this visit.
Amu
Comments;(refertgyqutisti n 0) lazp alii'any YES anew t a andloreanv recommendation"s'or any ntherncommentsF_ "AA
�y;
Usc,drawings of'facility t better expialn situations; (use additionatpages asinecessary,): ❑Field Copv ❑Final Notes'
p `
106L n{
to oal
w
Reviewerlinspector Name 4 � � � _Tj'
Reviewer/Inspector Signature; Date: b
05103101 `" Continued

Facility Number: — ,ZC, Date of Inspection
Ulu issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
3t. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentftemporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes (Q No
❑ Yes ® No
❑ Yes ❑ No
AdditlbfiAILComments�und/,or nra►vlttgs ';- . .' ,;ai r - ", dr ,
05103101
05103101

I'%
State of Norib Carolina
Department of Envlronment.
Health and Natural Resources
Fayetteville Reglonal Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
A V :FA
[DEHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 29, 1995
Mr. Thomas Butler
Rt. 2, Box 316
Lillington, NC 27546
SUBJECT: Compliance Inspection
Harnett County
Dear Mr. Butler:
On August 1, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
in compliance with 15A NCAC 2H, Part ,0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
D.T. Jones
Chemist
DTJ/bs
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Acton Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 4 " 1 , 1995
Time: I % 5 -0 pm
Farm Name/Owner: AarLflt- `glIlt`i
Mailing Address: L
County: ft
Integrator: Xs t- Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry . Cattle
Design Capacity: Number of Animals on Site: �0 _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of 1 Foot + 25 year 24. hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: rFt. Inches
Was any seepage observed from thenYes
(s)? Yes or(9 Was any erosion obUor
d? Yes orpl
Is adequate land available for spray?r No Is the cover crop adequate? No
Crop(s) being utilized. 71
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? Y No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ore
Is animal waste discharged into water of Oe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain. '
Does the facility maintain adequate waste management records (volumes of manure, land applied,
es spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
2 1 lfi7.�JoME S
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.