820709_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

7c
b.
of Visit: O-Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
in for Visit: alroutine Q Complaint 0 Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ' v Departure Time: ,3 County: �j Region:
Farm Name: tt C 1r ys-`_ Owner Email:
Owner Name: � ,yd� �j�d% Y-v Phone: �.
Mailing Address:
Physical Address:
Facility Contact: 'Le.
"III 0z;19rr_--- Title: Q Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: latitude:
Integrator:
Certification Number:
Certification Number-
Longitude -
�'
Destgn Current
Design
Current
Design Current
Swine
Capacity Pap
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Laver
Dairy Calf
Dairy Heifer
Feeder to Finish
p
e
Farrow to Wean
I Dry Cow
Farrow to Feeder
D . �;oult .
Ca ac'
I'o . _
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Soars
Pullets
Beef Brood Cow
�
Turkeys
Turke Points
.Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the,State other than from a discharge?
Page 1 of 3
[] Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[2�<
❑ NA
❑ NE
❑ Yes
9-<o
❑ NA
0 NE
21412015 Continued

Facility Number: O Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[J No
❑ NA
❑ NE,
a. If yes, is waste level into the structural freeboard?
[]Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Dl�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a'110
❑ 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 DV4 R
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
[] NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[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
Q'fIo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z"No
❑ NA
❑ NE
maintenance or improvement?
1 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Dl�o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application ApprovedArea
12. Crop Type(s): k sr ! ez2z,, e /Cr3 / ✓L
/Outside /of
�Gt�/f r. r/—/ J �"l�d s /
�r�
13. Soil Type(s): / 'Xj0 �'� 4 rZ / (a"4
l u t T3 1 e9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [2rl o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 2Ko
❑ 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
[3'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Vo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ -1�-o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Io
❑ 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 [3-<0
❑ 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 2"N' o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes i —1<0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: 7P7 - Date of Ins p ection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo
y 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E 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 Reviewed]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
[ETNo
❑ NA
❑ NE
❑ Yes
[ <o
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
L No
❑ NA
❑ NE
❑ Yes [] No
❑ Yes 2_1 0
❑ Yes 20
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question f#)r Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name: 5�'���
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

i ype nl v]stt: tti-xompna a inspection U uperation Keview v Ntructure Lvatuatton V i ecnntcat .assistance
Reason for Visit: outine Q Complaint Q Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: FT f35_ Departure Time: County:Region:
Farm Name:
Owner Name:?
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: .7�+c Kj t om-` Title: Phone:
Onsite Representative:_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
,- .: .
Design Curreat
Desigta
Current
Design Current
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
_AFeeder to Finish lit %?!�P
Dai Heifer
Farrow to Wean
Design
Curreat
D Cow
Farrow to feeder
Dry Foul
Ca aeity
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
&
Turkeys
ther x.:
OftR&,
Turkey Poults
Other
Other
Dischar es 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 evidettee 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 [a No ❑ NA ❑ NE
❑Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes C$g_No
❑ Yes r>-4-No
❑ NA ❑ NE
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page ! of 3 21412015 Continued

aci[i Number: Date of Ins ection: 3 U/
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): f 7
Observed Freeboard (in): d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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 P_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
T Do any of the structures need maintenance or improvement? ❑ Yes � No
❑ NA D NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z 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 Z 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 J No
DNA ❑ 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 ❑eEvidence of Wind/ Drift/ ❑ Application/Outside of Approved Area
12. Crop Type(s): fir�/yrls�6T �41/�✓SYYe' /l'7r..1 /�/h r/S�`3`�/�S"�, ~5r'c�j
13. Soil Type(s): R11 ,It,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
D. Yes
Callo
❑ 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 g 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 [Q No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑NA ❑NE
Page 2 of 3 21412015 Continued

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

/& _5 -h" 3 � �
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation Q Tecbnical Assistance
Reason for Visit: Prioutine Q Complaint O Follow-up O Referral 0 Emergency 0 Other Q Denied Access
-/�1
Date of Visit: - 7-/L Arrival Time: Departure Time: County: cQyQsv�— Region: '
'OV
Farm Name:
Owner name: r.-�-
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: �j.�G��;-F x Title: Phone:
Onsite Representative: S ��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design' , Current t Design @nrrent Design Current
t�
Swine Capacrty Pop. Wet Poultry Capacity Pop. Catkle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder Non -La er Dairy Calf
Feeder to Finish D'i7 p - - - Dairy Heifer
Farrow to Wean i Design Current Da Cow
Farrow to Feeder D . Maul Ca tci ,. 1Po . Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
A. ' Turke s
-'}� ....
OtherW _7 E - m Turkey Poults
Other Other
.��-�.y�'.b"sit:..Y.Oia:_u: _- - ._ �._ T� ... ..�-^-•^iIlliiifllhYlYYWlaaticKS.tii;.x'aF::. s�.s4an-:e.':;'t.�.::
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWI+;)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes © No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes CR No
❑ Yes � No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Eacili Number: - 7 Date A Inspection -
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E[ 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): jam}
Observed Freeboard (in): .�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[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
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
'-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/Applicatition Outside of Approved Area
12. Crop Type(s):lI?r1'r� �E�yz-��� C c� i�, �1���� / Sf�`71�r...��
��a-�srT�•
-
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a 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
[a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-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
[g-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E&No
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3-No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: IDateof Inspection:
f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EKNo
`25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FNo
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E, 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? I f 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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes EKNo ❑ NA ❑ NE
❑ Yes [gNo 0 NA ❑ NE
0 Yes allo ❑ NA ❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: -->-37on
Date: ;5-- / 7-/�
21412015

type or vistt: kE-FUompliance inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: - Y/ Arrival Time: F7,' 3 ° Departure Time: ' p County: f Region:
,or
Farm Name: !T cil L Owner Email: "
Owner Name: ��/~I %��. Phone:
Mailing Address:
Physical Address:
Facility Contact: =Gj�n, 1-fi g•—� Title: f�j"4f
Onsite Representative: _ .����_ Integrator
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: /ff3G'!K
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
lull
Wet Poultry
La er
Design
Capacity
Current
.._ Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
Non -La er
_ _ -:Design
Dr.P;OuI Ca aci
Current
Pa ..
Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[& No
❑ NA
❑ NE
Page l of 3 21412014 Continued

Faciiih' (lumber: i�?- 7p Date of lns ection: "/ /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
I
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
53-No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes [a No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes MNo
❑ NA
❑ NT-
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [&No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ N1
(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
❑ NTE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding [j Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu. 7_n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable
❑ Yes
®. No
❑ NA
❑ NF
acres determination?
17. Does the facility lack adequate acreage 1br land application?
❑ Yes
® No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
❑. No
❑ NA
❑ NE
R uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E? No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes © No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - jDate of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z 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 to provide documentation of an actively certified operator in charge? ❑ Yes [Z 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 docutnent ❑ Yes ® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes LCI
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes RNo
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 [allo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause nun -compliance of the permit or CAWMP? ❑ Yes LaNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [allo
❑NA NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exulain situations (use additional oases as necessarv).
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
J/Y f_�ry/j,�•-' Phone: 33 V0
G> � Dale: /
21412011

0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 820709
Facility Status: Active
Permit: AWS820709
❑ Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit: Routine
County:
Sampson Region:
Fayetteville
Date of visit: 0812112015 Entry Time: 08:30 am Exit Time: 9:30
am Incident 0
Farm Name: H&C Farm
Owner Email:
Owner: P Jart Hudson Jr
Phone:
910-533-3020
Mailing Address: 4901 Old Warsaw Rd
Turkey NC 28393
Physical Address: 1240 Cabin Museum Rd
Turkey NC 28393
Facility Status: Compliant ❑
Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
35' 00' Longitude:
78' 10' 58"
Take Hwy 24 to Turkey, NC. Turn right on SR1909. Farm is - 1.5 miles on right.
Question Areas:
Dischrge & Stream Impacts
Waste Cal. Stor, & Treat
Waste Application
Records and Documents
Other issues
Certified Operator: Richard H Clifton Operator Certification Number: 18368
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Richard Clifton Phone
On -site representative Richard Clifton Phone
Primary Inspector: Steve Guyton Phone:
Inspector Signature: Date -
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820709 Owner - Facility : P Jart Hudson Jr Facility Number: 820709
Inspection Cate: 08/21/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations design Capacity Current promotions
Swine
Swine - Feeder to Finish 7,040 1,000
Total Design Capacity: 7,040
Total SSLW: 950,400
Waste Structures
Disignated Observed
Type Identifier Closed Date Start hate Freeboard Freeboard
Lagoon 1 19.00 43.00
page: 2

Permit: AWS820709 Owner - Facility: P Jart Hudson Jr Facility Number: 820709
Inspection Date: 08/21/15 lnpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑0
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
01111
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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
01111
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
No
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? {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
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820709 Owner - Facility : P Jart Hudson Jr Facility Number:
820709
Inspection Date: 08/21/15 Inspection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes No Na No
Crop Type 1
Com, Wheat, Soybeans
Crop Type 2
Peanuts
Crop Type 3
Coastal Bermuda Grass w/
Rye Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Marvyn loamy sand, B to
t 2% slopes
Soil Type 2
Norfolk loamy sand, 2 to 6%
slopes
Soil Type 3
Nahunta loam
Soil Type 4
Lynchburg sandy loam
Soil Type 5
Goldsboro loamy sand, 0 to
2% slopes
Soil Type 6
Wagram loamy sand, 0 to
6% slopes
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ M ❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ 0 ❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ ■ ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ ❑ ❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ E ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WIJP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
page: 4

Permit: AWS820709 Owner - Facility: P Jart Hudson Jr Facility Number: 820709
Inspection Date: 08/21/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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:
2& Did the facility fail to provide documentation of an actively certified operator in charge?
❑
E ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑ ❑
Other Issues
Yes
No Na No,
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by 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 I Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ M ❑ ❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ 0 ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

Division of Water Quality
Faciltty,,Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: OTompliance 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: -/1 Arrival Time: d00 Departure Time: j z7a County: �5 Region:
Farm Dame: 1�f Glyy._ Owner Email: r`-10,`�
Owner Dame: 1fpols�..� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: �l
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
1>4 Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
C X0 'd e L .. /_"' Title: _,o�is c o Y gf`! jt •
Integrator:
Certification Number:
Phone:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
a er 3Non-Laycr
7Qi10
Design Current
Dry Poultry Capacity Pop.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
?. 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 . Currenf`r
Cattle Capacity, _ Pap i
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
No
❑ Yes
® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDateofIns ection: p— r
• 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 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 ZI 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 [�Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require]
Yes ® No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [X No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes FA 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 Drill ❑ Application Outside of Approved Area
12. Crop Tvpe(s):
13. Soil Type(s): - d C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility sail 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?
❑ Ycs
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z 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
® 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 JZ 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 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 21412011 Continued

Facility Number: - Date of Ins ection: D"-/S iq
24. Did the facility tail to calibrate waste application equipment as required by the permit? ❑ Yes r-17,1 No Q NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an activciy certified operator in charge? ❑ Yes 1Z No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_c., discharge. freeboard problems. over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 8 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes }Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to questions #): Explain any YES answers aadlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: cx�:>
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

■ yt,c UN r malt. qC=7­l..ULUP1lanCe tnspectlun V Vperauon 1Cevlew u strucxure r-valuanon �,j 1 ecnnlcal ASSlsrance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ;/ Arrival Time: f v Departure Time: County: �asQ� Region:
Farm Name 0f-G Owner Email:
Owner Name: 2:7 �, f' /Tl�dL�'8 n— Phone:
Mailing Address:
Physical Address:
Facility Contact: ,fie L Title: Phone:
Onsite Representative: _ S'd�� Integrator:�0� /1J urn
Certified Operator: Certification Number: /(
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
gCurr�ent�>`'"� Deslgn�Current Design Current
Swine Capaclty'*PopWet)F'oultry Capaclty�Pop r Cable Capacity Pop.
Wean to Finish 5`Lj
La er DairyCow
Wean to Feeder Non -Layer Dai Calf
Feeder to Finish - _ — Dai Heifer
Farrow to WeanDesign. urrent D Cow
Farrow to FeederTPsl?o At Ca act ,' Non -Dairy
Farrow to Finish t4 Layers ! Beef Stocker
Gilts Non —Lavers Beef Feeder
Boars Pullets t-,
Beef Broad Cow
�7
1Turkeys
Other Turkey Points ft
Other
Other -
Discharges and Stream -Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
® No
[] NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: LE- 0 Date of Inspection- — /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ® No D 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):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 ER No ❑ NA ❑ N E
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 [n2No ❑ 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 0 No DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes .q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101/4 or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2S No
❑ N A
❑ 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
U?No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
[] NA
❑ NE
Page 2 of 3 21412011 Continued

Facil - Ity IYumber: - p Datc of Inspection: /%IT I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IM No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Z 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 to 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
❑ .'ETA
❑ 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
FZZ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? 1f 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
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: gyp`-L�3�R3D0
Date:
21412011

le
Type of Visit: Orrompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: G / Arriva]Time:l 9V00 Departure Time: /F%,' /J County: sA!ap,��r— Region:
AV
Farm Name: [i Far► Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Aryt ��J
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: /ji/ur1
Certification Number:
Certification Number:
Longitude:
X � �Desig� Eurrent
CPo�
Swine C}CuProrent
M p ty p
��� C.M�
Wet+Pouit = CaeactV
ry pp attleCapacity Pop.
F
�
Wean to Finish
La er Dal Cow
)Non -Layer Dal Calf
'= t:w- Dairy Heifer
Desi k rep[ ? D Cow
_ D . Pooult - Ca actty�P:o airy
La ers a ` Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
:-urkeys..
.
Othff er:.
Turkey Poults
_
Other
Other3`
Discharges and Stream Impacts
I. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J23-No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility ,lrumber: - � Date oT Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
y
ElYes
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
M 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?
'*Paste 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 ELNo [] 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 ❑/Eviidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �r L "c/fez—a� Ile 0 �.K'— �Gu�t• � 7flr'�"`S ��air
13. Soil Type(s): p n r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M-,L 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 .vettable ❑ Yes )❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I8. 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 ®. No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily_ available'? If yes, check ❑ Yes EINo ❑ NA ❑ NE
the appropriate box.
❑NVUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [allo
❑ 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 S No
❑ NA ❑ NE
❑ Weather Code
[] Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: Date of Ins ection: /'�
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 [KNo
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
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?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
Comments (referto question f: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):.
Reviewer/Inspector Name:
Phone: / o — L35­3-301
Reviewer/Inspector Signature: Date: _%� --(p 1.;2—
Page 3 of 3 21412011

jP"flivision of Water Quality
FaCH ��
fy Number - � � Division of Soil and Water Conservation
0 Other Agency.
Type of visit: 0<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q'lfoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - // Arrival Time: !p !J Departure Time: ! D O County: Region: / � _J.
Farm Name_
Owner Name: %� ��r� e
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: R.-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine..
Wean to Finish
Wean to Feeder
Feeder to Finish
7D- b
D D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other ., -
I ,.
Other .
Discharges and Stream Impacts
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry. Capacity Pop.
U aver
Lon -Layer
Design Current
Dry Pouitry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
L 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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[K No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date oT Im ection: /p
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): Z—
Observed Freeboard (in): �[o
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes 24 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes � No
❑ NA
❑ NE;
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ELNo
❑ 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 No
❑ N A
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
[] NA
❑ NI
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 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): L_1_1 rzi
13. Soil Type(s): a $
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No 0 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 Eg No ❑ NA ❑ NEi
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ZI No 0 NA ❑ NF
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L?� No ❑ NA ❑ NF
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes V No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stock me, 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes R1 No
❑ NA ❑ NE:
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NI
❑NA ❑NF.
Page 2 of 3 21412011 Continued

Facility N umber-
709 Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
j 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 [� No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CR 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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [& No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to, question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: Or 3­33oa
Reviewer/Inspector Signature: Date: -
Page 3 of 3 21412011

Type of Visit (�,{,�,,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C1Rmp�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D.%l% Arrival Time: `Q[7 Departure Time: . �� County:.
Farm Name: t� ��'r" -' Owner Email:
Owner Name: ";7 _ /7t�Ir�S� _ Phone:
Mailing Address:
Physical Address: / �__j _,L�
Facilitv Contact: +G/rex'Ie! Z1 `! 0 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 1—ey
g
Location of Farm: Latitude: Oe =4 Longitude: =c 0, = «
Design Current
Capacity Poulation
❑ Wean to Finish
_ Design Current
- Wet Poultry Capacity Population
❑ I,aver
DesigM
urentRne
Cattle Capacpulation
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
eder to in 701,10
�.
❑ DairyHeifer
rrow to Wean
Dry Poultry
❑ Dry Cow
rrow to Feeder
Non-Dairy
rrow to Finish
❑ Lavers
❑ Beef Stocker
lts
LOG
❑ Non -Layers
❑ Beef Feeder
ars
❑Pullets❑
Beef Brood Cowl I
❑ Turkevs
• ❑ Turke Pouhsher ❑ Other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State" (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, 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 f.No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
El No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
Page I of 3 12128104 Continued

s
Facility Number: 9j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RrNo ❑ 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 J9 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 to No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below. El Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lhs ❑ 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) : sH.�f� i9 c�er� ram.✓ n vt %uJ,� �� S
13.
Soil type(s) Ma AZ4�1�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
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
[Z No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[9 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 Phone: 9�Q -�1133 33Dt7
Reviewer/Inspector Signature: Date:
I'uge 2 of 3
L/LO/V-1 l-Urfe F/ me:

Facility Number: �02 — p Date of Inspection L!
•' Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ 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 ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Jallo ❑ 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
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 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
3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L ,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J.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
[I Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewed]nspector 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
R No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

S
Type of Visit Q<o­mpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: - - a,-r t Owner Email:
Owner Name: 1P_ /Gzl _ _ITl1dSD -%— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _:5ror_r�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number. -
Back -up Certification Number:
Location of Farm:
Latitude: 0 0 [� I [� 11 Longitude: [� c [� It [� III
Ma
Swine a"
,...
Design
Capacity
Current
Paptilation
Design Current
Wet Poultry Capacito Population
.-
Design Current
CattleWava,y Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -Laver
❑ Dairy Calf
® Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry
❑ D Cow
Dry Poultry
❑ Non -Dairy
❑ Layers
El Stocker
Gilts
❑
El Beef Feeder
Boars
❑ Pullets
ElBee f Brood owl I
. F, .... ..,,.
❑ Turkevs
Other
❑ Other
❑ Turke Poults
❑Other
Number of Structures:
❑
El Farrow to Feeder
❑ Farrow to Finish
&Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
t& No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify UWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑Yes
[�J-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
e3.No
❑ NA
❑ NE
other than from a discharge?
12/18/04
Continued

Facility Number: — �D7
Date of Inspection �n ?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
S-No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZI 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
ESNo
❑ 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
3,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers. setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA ❑ NE
ma inte n an celi mprovemcnt?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of -Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop tvpc(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
93 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?
❑ Yes
® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name _ Phone:
Reviewer/inspector Signature: Date: 14?—v26
12128104 Continued

Facility Number: — 716Date of Inspection
. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ Design El Maps El Other
❑ WUP El Checklists
❑ Yes {3 No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 54No ❑ 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 pen -nit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional! Comments andfor.Drawings:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
fg-No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(9 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
12128104

❑ Wean to Finish
❑ Wean to Feeder
99 Feeder to Finish OND OO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
(vision of Water Quality LLL� r
Facility Number %p 9 0 Division of Soil and Water Conservation L/ (J
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit �Arrival Time: Departure Time: �County: Region:
Farm Name: &Tt-C ` - ll Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address
Facility Contact: J/a //7 lhdS`D "v/i� ��—Title:
G4c Onsite Representative: x;Q�-/� C—�
Certified Operator: X1 C-Aq/��1 (2-
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =u = [=,, Longitude: [=o[�,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ TurKe Ys
❑ Turkev Pouets
❑ 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DrvCow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co«
Number of Structures: F11'
b_ Did the discharge reach waters of the State? (If ves, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,j No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
�RNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

•r
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stricture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [RNO ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z 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 allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes �KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) (�G ,Z&'Ll ,/ 4n /4Z, 69 L.5 / z �G�LI
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
C4No
❑ NA
❑ NE
I &
Is there a lack of properly operating waste application equipment?
❑ Yes
O-No
❑ NA
❑ NE
Comments (ref& 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 ~- ���.'-'-_: Phone: ��T�"D
Reviewer/Inspector Signature: Date:�ooe
rage z of 1 It1-16iv4 t.ontrnueu

F.
Facility Number: Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes JO No ❑ NA ❑ NE
the approprrate box,
❑ WUP [I Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ 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
29,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Additional Comments. and/or Drawings:
Page 3 of 3 12128104

tvision of Water Quality /a —mar%
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: ��, liC� Departure Time r�(%V County;
Farm Name: rLfLoLG J—RZo 15 Owner Email:
Owner Name: �� t%ai'� k d1.50�'t— Phone:
Mailing Address:
Physical Address:
Facility Contact: '
!S " )a w �L/ Z4" � Title:
Onsite Representative: UGH--G
Certified Operator: . 5a+'1-e--
Back-up Operator:
Location of Farm:
Swine
to Finish
to Feeder
-to Finish
v to Wean
to Feeder
v to Finish
Other
❑ Other
Region:
Phone No: 91/D-9990 aZb3
Integrator:
Operator Certification Number: /,KTAf__�
Back-up Certification Number:
Latitude: [=o O, =,, Longitude: =u =1 = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr II
❑ Non -La cl
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy FIcifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
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:
d. Does discharge bypass the waste management system? (Ifycs. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes jKNo ❑ NA FINE
❑ Yes
[]No
❑ NA
FINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

J
Facility Number: —_ P Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (strtu'turai plus storm storage plus heavy rainfall) less than adequate? ❑Yes ®No ❑ NA ❑ NE
a. If ves. is Nvaste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZI No 0 NA ❑ NI -
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 allo ❑ NA ❑ N F
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 0 No ❑ NA ❑ Nl:
maintenance or improvement?
Waste Application
10- Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes k] No ❑ NA ❑ NIA:
maintenance/improvement?
11. is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn. etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind: Drift ❑ Application Outside of Area
12. Crop typc(s) � rnz e. /_©!/rrsz"t'� ,� Cf� a
_.
13.
/f
Soiltype(s)���� fZZ f���TT f WCl�C/C
/*_� ,�
lI/'�/� O/
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
CR No
El NA
❑ NE
15.
Does the receiving: crop and/or land application site need improvement?
❑ Yes
(3NI o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination''❑ Yes
0 No
❑ NA
❑ NE
17.
Does the facility lack adeequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment"
❑ Yes
5�No
❑ NA
❑ N 1:
Comments (refer to question 9): 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— Phone:
ReviewerAnspector Signature: Date: J_�p
IsnAm.t I ilft/IHIIDII

Facility Number:2r-- Date of Inspection
• Refit uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the approprrate box. El WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ 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 JE(No ❑ NA ❑ NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
P9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge'?
[] Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C,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
MNo
❑ 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
ZNo
❑ 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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

ivision of Water Quality
Facility Number ���
0 Division of Soil and Water Conservation
__ 0 Other Agency
Type of Visit
Compliance Inspection
O Operation Review 0 Structure Evaluation
a Technical Assistance
Reason for Visit
Zoutine O Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
' �"�- Region:
t Date of Visit: ,�L4�r� Arrival Timc: .,3� Departure Time: �� CountY' g'on:
Farm Name: / Cp4 C- F,2,e'W - Owner Email:
Owner Name: Tf a _�„ ��S r Phone:
Mailing Address:
Physical Address:
Facilitv Contact; hats CL; ^' Title:
Onsite Representative: S� =`-
Certified Operator: �—
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: �r f
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑o =, ❑" Longitude: ❑o =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
aFceder to Finish
JZ04f 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Cattle
Design =' Current
Capacity =:`Population .;
f;:
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy, Heifer
❑
D Cow
❑
Non-Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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 dischanye bypass the Nvaste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
M
[]Yes CgNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
IM No
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
E9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f J-
Obsen,ed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JX 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 15No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 14 No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E,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
JS No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[9 No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ga�� � Phone: C jD�� :3.3a0
Reviewer/Inspector Signature: ,� Date:
...5c uj r�Zilco.av %_UR n"rw

I . '
Facility Number: — % Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E9 No ❑ NA ❑ NE
the appropriate box. ❑ Wul' ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
KNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fA No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
jO No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
K No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
0 No
Cl 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
XLNo
❑ NA
ONE
General Permit? (ie/ discharge. freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
ANo
❑ NA
❑ NF
33.
Does facility require a follow-up visit by saute agency'?
❑ Yes
0 No
❑ NA
❑ NE
Additional Commeitts and/or Drawings:
Pa;; e 3 of 3 12128104

Eadlity Nt>imber
p
® Division of Water Quality
O Division of Soil and Water Conservation
4 �ly
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 ❑ Denied Access
Date of Visit: ti {Y-Oi Arrival Time: departure Time: County: ?SAn Region: 4110-0—
Farm Name: _t C 1EQ1101 Owner Email:
L c//
Owner Name: ,Tqr_` /7LCIA Phone: 1/4 -
,Mailing Address: L/_`TQ�_O.� w2rs.a�v %1?eecr 7.4,
Physical Address:
Facility Contact: 'V 'G�a.�C�,fnnrl Title:
Onsite Representative: � " c4i0.e&� 61"f7�a,,
Certified Operator. 4.1- GI f�nn
Back-up Operator:
Location of Farm:
Swine
Phone No: 9HOAMe
Integrator: C.4rro! S r1�1vr �, � .
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 { 1=1 « Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Lave[
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
GZo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Lagers
❑ Pullcts
❑ Turkevs
❑ Turkcv Poults
❑ Other
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation'?
Dischar-e originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current, I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairry Calf
❑ Dairy lleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State'? (Ifycs. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: FE
d. Does discharge bypass the xaste management system? (If yes. notify DWQ)
?. 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 E o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑No
ElYes
D No
❑ NA
❑ NE
❑ Yes
E4 <io
❑ NA
❑ NE
12128104 Continued

Facility Number: &—'7o9 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?: 492
Designed Freeboard (in): 1 Gj'�
Observed Freeboard (in): �2 q
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2'1lo ❑ NA ❑ NE
❑ Yes ❑'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
T Do any of the structures need maintenance or improvement? ❑ Yes [e o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑1No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes
91�o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[2 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[?No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12 305,
»r- 91 12 570
12. Crop type(s) _066'r-e2 fib S.,►n!/
T-
13. Soiltype(s) Z_A N, sio Ne� Wog AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E3 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[ o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
❑ No
❑ NA �E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA 2NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
R<o
❑ NA ❑ NE
Comments (refer to. question 9): Explain.any YES answers and/or any recommendations or,any,other,.commen&
Use drawings of facility, to better explain situations. (use_ additional pages as necessary): ^
me, 61jt AoP7 Is klb��'nI rN He if are, 4rdnw3 arov.,G( /4 g do-1
Reviewer/Inspector Name --�, Phone: �r7—rts4� R/G-Y_d4
Reviewer/Inspector Signature: eft,,a Date: lv
0091 12128104 Continued

Facility Number: —7o Date of Inspection
Refired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ -Mo ❑ NA ❑ NE
the appropirate box. , xi ❑ D,,i<n ❑ W ❑ C ists ❑ ❑ 4E
21. Does record keeping need improvement? If yes, check the appropriate box below. E4yes ❑ No ❑ NA ❑ NE
❑ ❑ wve6r Free aar l ❑i s ❑ _m ❑
s
04s� ❑ Stocking ❑.-rophiehl- ❑ 9-Monthly and I" Rain Inspections ❑ 4Vrff&crt�D
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge. freeboard problems, over application)
32, Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
B;�No
❑ NA
❑ NE
❑ Yes
E�no
❑ NA
❑ NE
❑ Yes
[g-No
❑ NA
❑ NE
❑ Yes
[g-10
❑ NA
❑ NE
❑ Yes
[D, <o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ZXe
❑ Yes 0 o ❑ NA ❑ NE
❑ Yes gj"1Qo ❑ NA ❑ NE
❑ Yes
Q-No
❑ NA
❑ NE
❑ Yes
M-T1 o
❑ NA
❑ NE
❑ Yes
El NA
El NE
ElB Yes
�2lo
"No
❑ NA
❑ NE
Additional Comments andlor,Drawings
#�1, PaltasC �ilr� `J�IPt6owG! ��G� I�Or /'ldirT�l� qnej
�717, /aLA r �e o4ye y )-ie earl o� oa 49 .
12128104

V
�. _. � ��eiR�": rn- v .a' '1rr�.��sa �'i /�.,�.,��lxs..--- -_ yr � j $ ,� -r'� rimy ♦_�
e�°Jfi�rRr , �R�nAtEr.�.C!aaiaty
y, �L uYJiiT'" uc'K.f'e�4wX� M ,'Y.'..n�?ts '�
aiSo ttn� Water
�� x ,� ��r.,,i � �`" a O ;,�'Seaey 5. - �:L�Y..��.":;: ,ram `,. -y --.. -� • - 'd`�c�' .`— >« .� .v ��'.es �� - _
I Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
#Reason far Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Fac'rlitt- Number :� G% � Date (if ��icit_ -/_d Time. 10: �Ci
Ant O erational Below Threshold
ETF-e—rm-itled Q t ertified ©Conditipnalh Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: yry Fo County: Fn U
-J LI Herr svq qiv s 3 � 3uao
Owner Name:Phone Na:
Mailing Address: _ ye1Co d/�a� I✓a�scs✓ �dnif 7',rkrY Al _�7f3 .7 9 3
Facility Contact: _ X1 Ic4aj-cl _/C% Title: Phone .Nw
Onsite Representative. -PL:C 4 rrJ Integrator: � t' F/ten �E A� "0 - 0 3
Certified Operator: -r �a air% __ C rl {}�., _ ___ _ Operator Certification Number: 19,362
Location of Farm:
Q-81kine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' �• 0"
Design Current
Swine rnnnrity pnnell-atinn
Wean to Feeder
'Feeder to Finish
17cqO
❑ Farrow tc 'W_ean
❑ Farro.v to Feeder
❑ Farrow to Finish
❑ ciats
❑ Boars
Design Current Design Current
Poultry
Capacitv PopulationCate on
La ,
I I❑
Dair•
10 Non -Laver
❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons 1LJ Subsurface Drains Present L Lagoon Area 1LI Sprat• Field Area l
Holding Ponds / Solid Traps I0 No Liquid Waste Management System
Discharge & Stream Impacts
2. Is any discharge observed from any part of the operation?
Dischar„ originated at: ❑ Lagoon ❑ Spray- Field ❑ Other
a Udischartr is obser-ed_ was the conveyance than -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 sal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Trea meat
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
0 Yes 26<0
❑ Yes //'o
❑ Yes Elf o
❑ Yes [9" o
❑ Yes
❑ Yes CIN10
Cl Yes
Structure I Structure 2 Structure 3 Structure 4 Structure { Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: ,) —rjp c7 Date of .Inspection / e
5. Arc there any immediate threats to the integrity of any of the structures observed? {ie/ trees. severe erosion, ❑ Yes lNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0ye5 ONO
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0440
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes io
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ONO
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 0440
1 I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Pondiing ❑ P%AN ❑ Hydr�a/ubc Overload [I Frozen Ground [I Copper and/or Zinc
12. Crop type S�PRnSi �['TJ✓ihal�/crr i� r �f�1 JC/C7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
I& Is there a lack of adequate waste application equipment?
Odor Issues
I7. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes &?Cb
❑ Yes D-Ko
❑ Yes & No
❑ Yes [ fo
❑ Yes ❑-le
❑ Yes ❑ No
❑ Yes BNo
❑ Yes O-Alo
❑ Yes 9-No-
Comments (refer to:gaesiian #) ^Explatu'aay YFS atasweis and/or any recomukindations or any, other. comments.
Use drawing M fadity to iietter explaui situatrans. {use adcLf,00al pages asnecessary)-z. ❑ Field Copy ❑ Final Notes
Reviewer/Ltspector Name „/
Reviewer/Inspector Signature:
Date: % 1-0
t6/t /uy Uonunaea

Facility Number:�� 7oc1 Date of Inspection 7-1- a
Reauired Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
tsts, dwi-g—njuap`s, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ W-aste-frppli�ation ❑ 1'reebomd- ❑ W*M--:i na€ysis ❑�g�
S• 7la--? 3 3
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32, Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the' appropriate box below.
Q-Stacid t- —,;n orm ❑-Rainfair ❑ lnspeetk"fter-t -Rain—
❑-A mrral-Eertification-Forrn-
■ L "Lj
❑ Yes S-No-
❑ Yes 0_�K
❑ Yes UN6
❑ Yes EIN6
❑ Yes ❑NG-
❑ Yes 0-No-
El Yes []_Ne -
❑ Yes Q-No
❑ems ❑ No
❑ Yes QNo
❑ Yes g'6-
❑ Yes El -No
❑ Yes U-No
❑ Yes allo
12112103

1\
6Divtston of Soil and Water Conservation ❑ Other Agency .
j�
Division of Water Quality V_tiv
d Routine 0 Complaint 0 Follow-up of D%V(2 ins cctian 0 roll ow- uof DSW(` review 0 Other
Date of InspectionL
Facility Number 2 Tirtte of Inspections / 24 hr. (hh:mm)
E3 Registered ® Certified 13 Applied for Permit 13 Permitted Not Operational Date Last Operated
Farm Name:........ _ 'e ��'v �Ier�L' �/'t T� Couniv A.. ......
...........................
....
--......
Owner Name:.............�.A .... •`.............................................................. Phone N01...3..."3
....-:30.I..Z.3...............
Facility Contact :.................. ....... Title:........................... Phone No: .....
MailingAddress: f� �� 4- a G ,`;>'Fal B
Onsite Representative: .... . ....:.....__ _......'� ........_......... Integrator�,
..�
Certified Operator:.....1t?�' P .. �, ,r.............................................. Operator Certification Number:..-
Lom[iotnof Farm; 7-,—Ic !1'__. 17 V [:,.. 4 17.a.--, i2�_ �,-._- ,P.� ./—, _ 1 -
....r-....�.... - ..,.¢ .�.........G'.........................................................................................- --
Latitude Longitude �• �� ��°
« Destga: Current Design Current M ` Design ;Current ,
Swine v. '"' Capacity Papulabon Poultry, :-Capacity. Population Cattle ° Caact#yPopuiation
w,s .a.
Wean to Feeder v
❑ Layer ❑ DAD Feeder to Finish p ❑ Non -Layer ❑Non -Dairy
❑ Farraw to Wean
❑ Farrow to Feeder 10 Other ,
x ❑ Farrow to Finish 'Total Design Capacity`
❑ Gilts
❑ Boars Total SSLW
-Number of Lagoons / Holdrrig'PondS © ❑ Subsurface Drains Present 110 Lagoon Area
I0 Spray Field Area,
x 1 i ❑ No Liquid Waste Management System
yx
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2. Is any discharge observed from any part of the operation'?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water`? (if yes, notify DWQ)
❑ Yes
JM No
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑Yes
P9 No
1 is there evidence of past discharge from any part of the operation?
❑ Yes
KI No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
0 No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
mai ntenan ce/improve ment?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

1
Facility Number: ?Z — -7
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes K) No
Structures (Lagoons Itoldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (b) .............'���C�� ...................................................................................................................................................
.
10. Is seepage observed from any of the structures?
❑ Yes
B$No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
JR No
12. Do any of the structures need maintenance/improvement?
❑ Yes
Eg'No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
PKNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
09No
(If in excess of or runoff entering waters of the State, notify DWQ)
/WMP,
15P h'P Dom`" "+{........................................... ........-.........---.---...............---.--.........................................-...-...........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
IT Does the facility have a lack of adequate acreage for land application?
❑ Yes
&No
18. Does the receiving crop need improvement?
❑ Yes
[9No
19. Is there a lack of available waste application equipment?
❑ Yes
($No
20. Does facility require a follow-up visit by same agency?
❑ Yes
Lallo
2L Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
XYes
it No
22. Does record keeping need improvement?
N Yes
❑ No
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
RYes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E9 No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
allo
[3 Noviolations or deficiencies were -noted during this, visit. :You�will receive�no ftirther
correspondence ah..oiA this visit..: .
Ise drawtir�gs of fattletyto better eatplaiit situations
Reviewerllnspector .Name
Reviewer/Inspector Signature:
Ddate:
7/25/97