820548_INSPECTIONS_20171231

NUHTH CAROLINA
Department of Environmental Qud

Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'vaa,_ Departure Time: (J County: Region:
Farm Name: ti92E Owner Email:
Owner Name: yv1S Phone:
Mailing Address:
Physical Address:
Facility Contact: Tarr -45 14" Title:
Onsite Representative: U
Certified Operator:
Back-up Operator:
Phone:
Integrator: res %
Certification Number: 1'-17%
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance matt -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
Design Current
Design Current
Design Carreot
Swe
Capacrty Pop Wet I'onitry
Capacity Pop
;Cattle Capacity Pop.
❑ No
a., , tit°
❑ NE
[] Yes
34
Wean to Finish
❑ NE
❑Lamer
Dairy Cow
Wean to Feeder
Non -Laver
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Gt:
Dry Cow
Farrow to Feeder
D . Poul
Ca aei ;T Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker.
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
L Beef Brood Cow
- Turkeys
I'
OtherW1
I ITurke Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance matt -made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`-e No
❑ Yes
❑ No
NA
❑ NE
[] Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[:]Yes
qNo
❑ Yes
`-e No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21411015 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfal I) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
10 NA
❑ NE
S I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2A rr
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.)
T,
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure pian?
If any or 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
M No
E]NA
E]NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes(�
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T__
9. Does any part of the waste management system other than the waste structures require
❑ YesNo
Ep
❑ NA
❑ NE
maintenance or improvement?
Waste Aoalieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
I I . 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, 7.n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑�Eviideence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S �SN� • �..
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r" No
F] NA
[—]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[e] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q; No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No E]NA [jNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C�j No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C� No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

fvacility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No
❑ Yes 1PNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Ir No [] NA [ ] NE
❑ Yes Lg No [] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ jRNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
p :man
li k .. ,. �. r� -_ > , . I.n i,llr,a. 9�u recommendations Or any other eRlnment5 f _- I
omtmeutsi(refeir to gneshon , Ex la y YES s.,nswers and/or any addtttonal recom
" fi I ,ti il! 11 � I
10Aawin s orfa itity to.better:: exV ain situations (ase additional names as necessary): -_
Reviewer/Inspector Name-
Reviewer/Inspector Signature_
Page 3 of 3
Phone: r1 al�'3 -1361
Date:
21412015

Hype of visit: ® Compliance Inspection U Operation Review O Structure Evaluation (> Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: & Arrival Time: F61_R3_a.1_1 Departure Time: Qgf County: JA * 1eU4A) Region: /C4"
Farm Name:_ 1 rY4N A, _T - cel Owner Email:
Owner Name: f/tS4r4C;.O_ f -d. -v -w ► s Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: Integrator: pf-YSLM r�
Certified Operator: JLT�frCertification Number: ( f
Back-up Operator:
Location of Farm:
Latitude.•
Certification Number:
Longitude:
Discharees_and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes [�] No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C, What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes ❑ No
❑Yes � No
❑ Yes �] No
NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
Page I of 3 2/4/2011 Continued

Ficili Number: - 417 Date of [ns ection:
I 4F
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Struer
e I Structure 2 Structure 3 Structure 4 Structure 5
identifier;
N No ❑ NA ❑ NE
[—]No NA ❑ NE
Structure 6
Spil Iway?:
❑ Yes
(P No
`i'''
F] NA
Designed Freeboard (in);
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
Observed Freeboard (in):s�
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No
E] NA
C] NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
rXNo
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes fn No
❑ NA
❑ NE
waste management or Closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
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
T�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes /M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, setbacks, or compliance alternatives that need
❑ Yes F%3No
E] NA
E] NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RD 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 ofAcceptable�C,r�p Window ❑ Eviden >�of Wind Drift ❑ Applicatio�nj 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
(P No
`i'''
F] NA
E] 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?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
rXNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the 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
V3 No
❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
rXNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V 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
P No
❑ NA ❑ NE
Page 2 of 3
2/412011 Continued

Facility Number: Date of Ins ectioa:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below. T
n 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
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [� 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 Q No
0 NA
E] 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 #)..Explain any YES answers and/or any additional recommendations -or any.other commentsR
3 k
Use drawings of facility to better -explain situations (use additional pales as necessary).'
sR4=
J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011'

Type of Visit: IF Compliance Inspection V Operation Review V Structure Evaluation U 'I'echnical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: a ;pp Departure Time: County: Region:
Farm Name: 7?Vd / Owner Email:
Owner Name: _&:6& rests Phone:
Mailing Address:
Physical Address:
Facility Contact:yQ�-''`-�—�"> Title: Phone:
1�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator: r rVSP9H
Certification Number: ` 77 9�6
Certification Number:
Latitude: Longitude:
Design
CurrentDesign
[P NA
❑ NE
Current
Design Current
Swine Capacity
Pop.
WefPoultty
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Ga er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
i;-
Dairy Heifer
Farrow to Wean
Design 'Current
Dry Cow
Farrow to Feeder
D .:P.oiilCa
aci
$o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Z.
Pullets
Beef Brood Cow
Turkeys
Outer
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)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify D)WR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑No
[:]Yes PNo
❑ Yes P No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

FAcili Dumber: - Date of inspection: 11113115___j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�a NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
W No
Identifier:
❑ NE
18. is there a lack of properly operating waste application equipment?
Spillway?:
® No
❑ NA
Designed Freeboard (in):
Required Records & Documents
2-1 14
Observed Freeboard (in):
[] Yes
[0 No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P@ No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
� No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes t No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes Q No E] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Pg 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 Pn 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?
1 I _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes R 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): CA416 s5 rye, t— t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes [�bNo ❑ 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 9 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W 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
[0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA
E] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 2/4/2014 Continued

FatiliNbmber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes X No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gg No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 'W No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [;a No ❑ NA ❑ NE
0 Yes P No ❑ NA ❑ NE
❑ Yes Pq No ❑ NA ❑'NE
[] Yes LM No 0 NA ❑ NE
❑ Yes 4 No
❑Yes 4 No
❑ Yes Un No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 11
k&::
Page 3 of 3 2/4/2014

a
type of visit: W t:ompuance inspection U operation Kevlew U structure Evaluation U Iecdntcat Assistance
Reason for Visit: 0 Routine a Complaint Q Follow-up O Referral Q Emergency Q Other Q Denied Access-,
Date of Visit: !r 3 Arrival Time: 03:m t" Departure Time: ; 00 County: Sd.#J Region: VnAO s
Farm Name: C h�- P., A, Ce -4- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:h0[aap Title: Phone:
Onsite Representative- :j-a-[..�es' ja^_4 Integrator:
-e
Certified Operator: t Certification Number:
Back-up Operator: Certification Number:
Location of farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes V] No ❑ NA ❑ NE
❑ Yes [—]No ® NA D NE
0 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 [;q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®No DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA [:]NE
of the State other than from a discharge? ��
Page I of 3 2/412011 Continued
Design Current
Design
Current
DesignCurrent
Swine
Ca MU IL Po
Wet Poillt Ca aci
r
Cattle Ga aci Po
Wean to Finish
Wean to Feeder
La er
Non -La er
Da' Cow
D ' Calf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
Farrow to Feeder
D , P,oult .
Design
Ca aci
Current
Po
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
FNon-Layers
Beef Feeder
Boars
2
Pullets
IBeef Brood Cow
111
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes V] No ❑ NA ❑ NE
❑ Yes [—]No ® NA D NE
0 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 [;q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®No DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA [:]NE
of the State other than from a discharge? ��
Page I of 3 2/412011 Continued

Facility Number: WE - jDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes]
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify 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
[�6No
❑ 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 r ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ( cZ5,k( •. dc. g'4SS wa', ), . Ck r', " Q V e,T�
13. Soil Type(s): Vial
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No ❑ NA ❑ NE
❑ Yes 1�3 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 CA WMP 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 [n No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis D Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Fa-cili Number: -511 Date of inspection: till
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
M No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes
fE 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
omments (refer to question ft Explain any YES answers and/or any additional recommendations;or any. other comments.'
FU
se drawings of facility to better explain situations:(iirse additional pages as necessary)._:
'z
Reviewer/Inspector Name: 1:?C r' 1 &A
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]o
Date: [1/14jl-3
2/4/2011

Ij ype of visa: d uompuance inspection U Uperation Review U structure r;Vatnanct,n
on U I eical Assistance
Reason for Visit: *'Routine Q Complaint O Follow-up O Referral p Emergency Q Other O Denied Access
Date of Visit;� Arrival Time: Departure Time: s t3 Countyrlf)
Farm Name: �n P (� Owner Email:
Owner Name; Q (Y-) S Phone:
Ili
Mailing Address:
Physical Address:
Facility Contact: (res Lam Title:
li
Onsite Representative:
Certified Operator: ,
Back-up Operator:
Location of Farm:
Region:
Phone:
Integrator:
Certification Number: i T7
Certification Number:
Latitude: Longitude:
Design. Current
E] No
Ej NA
❑ NE
E] Yes
E] No
Eq NA
[3 NE
E] Yes
Design
Current.
NE
Design
Current
Swine CaPscity ,. Fop.
Wet Poaltry
Capacity
Pop.
Cattle Capacity
Pap.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Po.
Ca aci
Po
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turke Moults
Other
Other
Discharp.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)
e. What is the estimated volume that reached waters of the State (gallons)?
E]Yes ®No [DNA E]NE
Yes
E] No
Ej NA
❑ NE
E] Yes
E] No
Eq NA
[3 NE
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?
E] Yes
[D No
® NA
❑ NE
E] Yes
® No
E] NA
[] NE
E] Yes
® No
❑ NA
NE
Page I of 3 2/4/2014 Continued

Facility Number: a - 546 1 jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
;g NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in); �y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rM No
❑ NA
E]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
jg 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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
N] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �I 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 hWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
CropType(s):Czv_:s leer rnu�0 wrcLSS b ) Sm0-7v'060
j
12. Cro eta �er���
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ,® No ❑ NA [] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ 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 IN No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA [a NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of los ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rM No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P] No ❑ NA ❑ NE
❑ Yes ® No
[—]Yes 0 No
❑ Yes fa No
F] NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: r�3"
Date: Zl
Z/412014

type of visit: W Compliance Inspection U Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Z Arrival Time: D Departure Time: ,L?JQ County: S7r'tr,50AI Region:
Farm Name: l r TU/) A. T• Cf Owner Email:
Owner Name: Tnes qe terns 7/ C Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �RiyY�� L'rti^�7
Certified Operator: _ Ail&
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: T -f
Certification Number: I l r��196
Certification Number:
Longitude:
q
Design Current -
NA
Design
RN
Current
Design Current
Swine
Capacity" P p
I+
WetiPoull ,
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
§1
INon-Layer
I
Dairy Calf
Feeder to Finish
`I' .. '' "
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P■oW
Ca aci RymP,o
."
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream IMP2CtS
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
❑ No
P NA
❑ NE
❑ Yes ❑ No
[:]Yes M No
❑ Yes f{ No
® NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
Page I of 3 214120II Continued

Facili Number: jDate of Inspection: 101L
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
PDNA
❑ 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
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on-site which are not properly addressed and/or managed through a
[3Yes
IM No
LM
E]NA
C]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
en
I � No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q9 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Bwm" &4f'S &1) SM, C%v*uou, 5a�
13. Soil Type(s): [/l B
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 �S No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 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 E] other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

[Facility Number: 2 - Date of I n T ecti0n: jell
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
El 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
omments (refer to question #1): Explain any YES answers and/or any additional. recommendations or_ any other comments:_
F
se dr-wings;,o.f.facil tyto better explain situations (use'additiorial pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -f/0 7 �1 iT-i/
Date: /O t J 2
2/412011

I ype of visit: ! Compliance inspection U Operation Review U Structure Evaluation U Uechnical Assistance
Reason for Visit: S Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:/�® Arrival Time: Departure Time: OS±oo County: �Yl Region:
Farm Name: l� 0 Irl. A -C-71- (%� Owner Email:
Owner Name: fL°6'�s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �� s
Certified Operator:
Title:
Phone:
Integrator: ftll7 q
Certification Number: / r I /
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream ImDacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Des[gn Current
❑ NA
Design
Current _
Design Current
Swine
Capac[ty Pop
Wet Poultry
@apacrty
Poi
Cattle Capacity Pop.
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)?
Wean to Finish
Wean to Feeder
La er
Non -La er
I
❑ No
Dairy Cow
Dairy Calf
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Feeder to Finish
No
"-'
❑ NE
=
Dairy Heifer
No
Farrow to Wean
Farrow to Feeder
❑ NE
::
D , _P,oul
Design
Ca aci
Current
Po .,
Dry Cow
Non -Dai
Farrow to Finish
I Layers
113eef Stacker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkex Poults
Other
Other
Discharges and Stream ImDacts
I. Is any discharge observed from any part of the operation?
❑ Yes
P� No
`"�
❑ NA
E] NE
Discharge originated at: El 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

[Facility Number: pia, Date of inspection: --(/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
KM No ❑ NA ❑ NE
TT❑ No NA ❑ NE
Structure 6
Spillway?:
❑ Yes
ER No
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
0] No
❑ NA
❑ NE
Observed Freeboard (in): 3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
® No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
%No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rn 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): Q141"
13. Soil Type(s): t4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes QI No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ER No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Vj No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Fitcili Plumber: Date of Ips ection: —W
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rM No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes n No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ YesNo ❑ NA [:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No N NA El NE
Other Issues
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document
❑ Yes G No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
JZ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
[—]Yes
S 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
{Commients (refer to questiowft Explain any YES answers and/oran additional recommendations or. any�
oEher co nvn
Ise,diivings 6Ufacility to.. better explain situations (use additionalag�es is`necessary).
Reca4s reV I ,1"1
SES IA`st4- 6a44 6 ( ��yw,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9(0-(t3 F336D
Date: 94 '/—(/
2/4!2011

Division of Water Quality
Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4BRoutine O Complaint O follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: WIS110 I Arrival Time: D el, O / _Departure Time: Q 2 County: �9� Region: '0
Farm Name: I A. -�' �► �`1f'->fr Owner Email:
Owner Name lis r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:��✓��
Certified Operator: tl _„ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =.
F7Longitude: ❑ o ❑ f 0 u
Design Current
his, 111, 1 111111 111,
Design Current
Design Current
Swine rC6apacity Population
Net Poultry .. C«apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ Yes T No ❑ NA
iry Cow
12/28/04 Continued
❑ Wean to Feeder
on -Laver
iry Calf
❑ Feeder to Finish
' "
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Nan -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
JEI Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
'age 1 of 3
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No RNA
❑ NE
❑ Yes [P No ❑ NA
❑ NE
❑ Yes T No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Stru ture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in): -2_q11
❑ NA ❑ NE
NA ❑ NE
S eturc 6
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 1P 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
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 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 El E'id'
of Wind Drift [3ApplicationOuttsi_de, of Area
12. Crop type(s) Galf �1Rnt i0ltit L]� SS 'M) r -5;'t .
13. Soil type(s) Q
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 03 No ❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No ❑ NA ❑ NE
'C6hf&e " (refer to .question:#) Egp in any YES;,answers and/or any ecom nendations ordany other comments
Use drawings of facity #o better explain sttuahons. {use additional pagesas necessary)
77
Reviewer/Inspector Name w
"
Phone:
r tea r
Reviewer/Inspector Signature:
Date: jU 0
Page 2 of 3 12/2$/04 Continued

A •
Facility Number,a s Date of Inspection )
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No [INA ❑ 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 [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes[__1NA
[:1NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYesPOQ9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�yy,, No
El NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[CI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
j] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'M No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit * Compliance Inspection O Operation Review 4 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral D Emergency O Other ❑ Denied Access
Date of Visit: ArrivalTime:/.OpDepaureTime: County: �0A Region:
Farm Name:
• J—� C-�P.Y� _ Owner Email:
Owner Name: M2jfi2QC, f7QLf_hA t Phone:
Mailing Address:
Physical Address:
Facility Contact: "6204 Title: Phone No:
Onsite Representative: b Integrator: S
Certified Operator. �"f � � Operator Certification Number: 177 6
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 ` 0 a Longitude: = ° = I = u
Design Current
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
W—M-Iurrent
Design Current
Swine Capacity Population
Wet Ponit , Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Laver
I
❑ Dairy Calf
❑ Feeder to Finish
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dai
❑ Farrow to Finish
❑ rs
La e
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Co
[9 No
❑ Turke s
❑ NE
Other
❑ Other
❑ Turkey Poults
❑ Other I
s:
Mom
❑ NE
other than from a discharge?
Discharges & Stream Impacts
I . 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
;RNA
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
77--71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[9 No
[:INA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(!�)No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: Date of Inspection
❑ Yes
& No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5� No
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N5No
[:1NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[)PNA ElNE
Structure I Stnicture 2 Structure 3 Structure 4
Suructure
5
titructurc 6
Identifier: i
❑ Yes
J�j No
❑ NA
Spilkvay?:
Designed Freeboard (in):
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I'ZNo
❑ 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 markets 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
�1 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tf No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�0 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 El Application Outside of Area
12. Crop ty*s) - t5 -6l _ urnlyd _� 6.. rl�.) f 5m. lryr2(,
13. Soil type(s)
14. Do the receiving Clops differ from those designated in the CAWMP?
❑ Yes
& No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
rM No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f�] No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�j No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: C1 lo' 4.35::]k
Reviewer/Inspector Signature: Date:
t 2abrlW tonnnuea

Facility Number: — Date of Inspection I K�
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ VPJp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[j�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesNo
[:3NA
ElNE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ 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
I No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[:1 Yes
V1 No
❑ NA
❑ NE
]2/28/04

J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:' 27 Arrival Time: Departure Time: �''-�Q County: -sir Region:,`
Farm Name: . b Al Owner Email:
Owner Name: S �— S - 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: &A/?QA7_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=O =1 = Longitude: = ° = "
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes PINo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Design Current
Swine
!90�69­trren
Capacity Populate n�!WettPouttry ;Capaty
Popula_atw
Finish
- � fik'Y ,.S.,ACUml 0 x.Ii:,. O._.. �!�
y ❑ Layer
❑ Dai Cow
Feeder
❑ Non -La er ❑ Dai Calf
Finish
_:❑Dai
Heifer
VMeano
Wean❑
onitry�,
D Caw
Feeder
—�.si'..❑
Finish
La ersNon-Dairy
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
Boars
❑ Pullets
❑Beef Brood Co
El NE
El Turkeys
El Yes
Other
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
umbetru
N ctures:Ell
Page I of 3
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes PINo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
nNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesPNo
o
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

J
Facility Number: 139— Date of Inspection L 8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NoS' 1A ElNE
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? ❑ YesTo El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes KNo [:1NA ❑ NE
through a waste management or closure plan? II
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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 1P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes b No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L S j &ou4&Q&,r 6_�S . ) ] - . (fir 4L
13. Soil type(s) VVQTfl3A44--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
EINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
5 No
❑ NA
EINE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
]M No
❑ NA
❑ NE
e ( ° Yq" } aay YES answe s andlorany rtmendations ar aay other comments.
Lice ImSsreof,factli�eto i;etter ex� Iain
gs typ situahoos (use#addrtronal p asFnecessary):
AL
Reviewer/Inspector Name T
= Phone Q
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection f l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ffNo ❑ NA ❑ NE
the appropriate box. ❑ WUP
❑ Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No [--INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�j No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�3No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
g} No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I&No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
PE No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E5 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
F9 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
�j No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Wo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5No
❑ NA
❑ NE
Additionat Comments and/or Drawings: .. `
y 4
AL
t
Page 3 of 3 12/28/04

.pivision of Water Quality1
lraeility NumberS 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit I&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Inj M�E
Arrival Time: 4) t0 Departure rime: lO.3 a County: Region:
Farm Name: C I �nd� A , 1 • --i 1A'r Owner Email:
Owner Name: �_ �_�s4s, valm, Phone:
]Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
10 Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Latitude: F7' = ' =" Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
E Laer
Non -La er
Dry Poultry
U Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design `' Current
Cattle Capacity POOW4tion
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �3No ❑ NA ❑ NE
❑ Yes
[N No
KNA
❑ NE
❑ Yes
❑ No
99NA
❑ NE
❑ No 0 NA
❑ NE
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
11/28104 Continued

oa
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in).
❑ Yes '*XNo ❑ NA ❑ NE
[]Yes_':3-lo ❑ NA EINE
Structure 5 v Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes �EM
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes �
❑ 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 Anvo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes r 10
❑ 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 Cj�No
❑ NA ❑ NE
maintenance/improvement?
H. . 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 Drifl ❑ Application Outside of Area
12. Crop type(s) -1Y-, C ✓
13. Soil type(s) Waz_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No
17. Does the facility lack adequate acreage for land application? ❑ Yes No
18. is there a lack of properly operating waste application equipment? ❑ Yes"'allo
Comments (refer to question if): 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 "�ow, D9 1 Phone:
Reviewer/Inspector Signature: Ay Date:
124
❑ NA ❑ NE
El NA [__1 NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Continued

r
Iia ility Number: — Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F No
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
g] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
r
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
fO No
El NA
[:1 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
❑ YesNo
❑ NA
ElNE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require afollow-up visit by same agency?
ElYes
�jNo
❑ NA
ElNE
Comments and/or Drawings:
12/28/04

NZ
I"
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `/ �% C� Arrival Time- f'/�- Departure Time: County: Region: RQ:o
Farm Name; %q T, c .�, �i a Owner Email:
Owner Name: �c fay Phone:
Mailing Address: % 19 oX
Physical Address:
Facility Contact:
Title:
Onsite Representative: I c c, i t - �. C*_ F,h
Certified Operator: R
Back-up Operator:
Phone No:
Integrator• Prz i' c -c
Operator Certification Number: 1 74
Back-up Certification Number:
Location of Farm: Latitude: 0 6 El ! 0 " Longitude: = ° 0 w
S�viue
Design Current
:Capacity P.ualation
WettP€�itItry
xca r,
-Design Currents
Capacity 1PvpulaoA
._Design Current
Cattle�''YCapacity Population
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
to Finish
❑ La er
❑Dai Cow
to Feeder
❑ No
❑Non -La et
❑ NE
❑Dai Calfr
to Finish
❑ No
❑ NA
❑ NE
❑Dai Heifer
w to Wean
❑ D Cow
w to Feeder
❑ No
;"""❑
❑ NE
Non-Dairyw
FFe.
to Finish
❑ No
s
❑ NE
❑ BeeFStocket
❑ Yes
❑ No
❑ NA
❑ NE
[� BeeFFeederG
J/
ulletsd
CoTurke
11/28/04
Continued
sTurke
PouIts
❑ Other
Number of structureS.ELI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
01 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of'the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
11/28/04
Continued

Facility Number: ,Z — S y . Date of Inspection`t /J C-%
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): �o
Observed Freeboard (in): -1:16 "
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
A.
(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
(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
© No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
© No
❑ NA ❑ NE
maintenance/improvement?
IL _
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12.
Crop type(s) _ Z?C
13.
Soil type(s) 61_ a'06
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Qa No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', E] Yes
[;] No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
X_
, 'b '
`
Phone:
Date: yb7/ate
A.
12/28/04 Continued

I~acHiry Number: Z -.ySi� Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes II] No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WC 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[o No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss 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
R3 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ud No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of'emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
6 Na
❑ NA
❑ NE
12/28/04

L
Type of Visit g2outine
Bance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � Departure Time: M
Farm Name: -I. c--+ 1f.Y
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 4
Certified Operator:
Back-up Operator:
County: �59ft Region: �—_Q
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ ❑ Longitude: 0 ° ❑ ❑ u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Eallo
❑ NA
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C*opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
❑ Wean to Feeder
❑ Non -La er
❑ Da Calf
❑ Feeder to Finish
[I No
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
Boars 3
El Pullets
❑ Beef Brood Cow
❑ NE
❑ Turkeys
-
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Eallo
❑ NA
EINE
Discharge originated at: El Structure El Application Field El Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
NA
[INE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
[I No
,�
Lel NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
P NA
EINE
2. [s there evidence of a past discharge from any part of the operation?
❑ Yes
e No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
FNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: Za Date of Inspection�J�
❑ Yes
[�LNo
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P 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:
❑ Yes
LNo
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
0'f,4o
❑ NA
^u
Observed Freeboard (in): aZ r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
(--INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
I�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 [:1NA [:]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
E] Yes
//
[9'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ANo ❑ 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) Q-1'ry�6� P� �Y1 C -5w of
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�LNo
❑ 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
E34,�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0'f,4o
❑ NA
❑ NE
Comments (refer to question #): Explain any W$ answers and/or any recommendations! or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary) =spy
Reviewer/[nspector Name` Phone - 91-0—
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04
Continued

w •
Facility Number: — Date of Inspection
Required Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 02'(No ❑ NA ❑ NE
the appropriate box. ❑ WU, 0 Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
B No ❑ NA ❑ NE
B"
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes;N0N
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
,�❑
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L<0�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
12"Ro
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[INA
[INE
2(a.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
��,.],/No
LT�J "No
❑ NA
❑ NC
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
11dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ff'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
2 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
B No ❑ NA ❑ NE
B"
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes;N0N
,.
❑ NA El NE
33. Does facility require afollow-up visit by same agency?
El Yes
El NA ❑ NE
Additional Com>inents.a'nd/or Drawings:
Page 3 of 3 12/28/04

f.
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
Date of Visit: -Di 'rune: 3
FFacility Number
Not rational 0 Below Threshold
UF'e-rmitted []-6ert fred 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: ......... ...11 efilf''_..................... _.... .......... .------ ------ ---- .................. ..... County: 4rtt, SQn............... w ...� d.....
Owner Name: ,f. !',G If .E ......�4?/ cn,%...... Phone No:. ............. ... ---JL-
. �. _.. .. .
Mailing Address:
Facilitv Contact: L3_�11r �.T � at {�! ..---- Title:.., .._� .......�. _�W .. Phone No: ---- — - _
Onsite Representative: •_ !z� � _ Q�*f� 4=f -- ------------------ --- _.. Integrator. PCCS��}� .--•�BC.lta `s ._...__-___
Cert'if'ied Operator: -_ Rc��/µ_ms _�u/gds._ ..._ Operator Certification Number:
Location of Farm:
Ea'iwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 44 Longitude 4 46
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [;�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes PNo
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ©
c. If discharge is observed, what is the estimated flow in gaUrnin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes © NO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [RIK0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Qlb3o
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identilicr-
Freeboard (inches): 30
12112103 Continued

• Facility Number: gg —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes EJ&
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes Ml�o
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 P -f o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes E34)
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes P o
. elevation markings?
Waste Anulication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes �o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes E3'X'0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cok?4U t Mel // �-IIVO'ti
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes G No
14. a) Does the facility lack adequate acreage for land application?
r b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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 [g -mo
❑ Yes EWb
[:]Yes (].Ado
❑ Yes [j.Ko
❑ Yes �o
❑ Yes &Ko
❑ Yes PNo
❑ Yes ❑ i<fo
❑ Yes El?o
Conus {refer to quesh #) Fxplam any YES swe`ts andJo� any recommendations or _ ny th r cemments.LL
;Use drawuegs of Ifaty to better explain sztosi�ons {use addrfianal Pages as necessaEry) , teld COPY E] Final Notes
-_ ::.T_ � _. .. .. ,.:,7.M ,.«.�«s=... -:x�.- .. �:� .�._�._ ry e -a;... _ S"Y�-. s - �«.:.�'_.._...' %-. v�_:.-_ : '�""'x .,...x-- .
�#
z-'- � .• - s
-
T
Reviewer/imp j- �J
ector Name /i4.� Iw'Q1�ai`!•r—;
Reviewerlinspector Signature:
Date.
12112103 Continued

M
Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EWo—
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
c4pc �Ae caf,' bral,oh OP cvosJd a11P)"cckV"On eyu,P�rF.z� 4-,-/d 6 e
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Q-Af'o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
9-K
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
S -Ko
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
a% -o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
[]-No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[ .No'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Q-90
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
9 -fes
❑ No
31. If selected, did the facility fail to install and maintain tainbreakers on irrigation equipment?
❑ Yes
[e�o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
11 - o
33. Did the facility fail to conduct an annual sludge survey?
9--fe- s
❑ No
34. Did the facility fail to calibrate waste application equipment? E3 -Y -es ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes g3-90
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
JG'No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttoiial Commcnts'andlor Diawtngs r j -=
Or" _. , a ;. e: tom.
...:. _... IMF -
Gj yyy�1 /} ,L 11 1 �I J
3 3 anon # 3 ( /►!l'. gal -C �Ool Sfa 61 f4a! +hE annual ,$,vu96 5vrvey
A.
c4pc �Ae caf,' bral,oh OP cvosJd a11P)"cckV"On eyu,P�rF.z� 4-,-/d 6 e
�� II
s y AAe end of Ao-,- a2Oot(,
)':�Orrn I ool s G coel
,
,! ecorC1s I oole 9 oedl
12112103

eneraI Information:
Farm
Owne
On Site Representative:
Mailing Address:
Facility Number. -Id, -r3q
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:z// 2 -
Time:
Time: a 'r
K �
5
lo: 59a - S77 f
C -
Physical Address/Location: u 5 q2-1 ra ~I
Latitude:— / / Lon 'tude: I I
O ration Description: (based on design characteristics)
Type of Swine No. of AnimaLs Type of Poultry No. of Animals Type of Cattle No. of Animals
3 Sow ❑ Layer © Dairy
0 Nursery 0 Nan -Layer a Beef
❑ Feeder _
Other -T} pe of Livestock �� r � Number of Animals: ? 3 3
Namber of Lagoons: �� (include in the Drawings and Observations the freeboard of each lagoon)
S'-`
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes CJ
No Q --
Is seepage observed from the lagoon?:
Yes C3
No Q-�
Is erosion observed?:
Yes ❑
No Q—
Is any discharge observed?
Yes Q
No 0�
Q Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No
Does the cover crop need improvement?:
Yes O
No EL-
( list the imps which need improvement}
Crop type: Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑ ,
No Com`
Is a well located within 140 feet of waste application?
Yes U
No
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
NoQ,�
Is animal waste Iand applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
Nom%,
AUi — Jany 17,1996 -

Maintenance
Does the facility maintenance need improvement? Yes D No �r
Is there evidence of past discharge from any part of the operation? Yes U No W---'
Does record keeping need improvement? Yes C❑ No CY
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes 0 No
Explain any Yes answers:
Signature
tc: Fueiiiry ASMS=tnr unu
prawings or Observations:
AOI -- January 17,19%
Date:_:.
V.ir An=hmenrs if Needed

Site Requires Immediate Attention: NO
Facility No. 1%;C6- '3Z_ ray
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3~•& l y IS , 1995
Time: 9: 50
Farm Name/Owner: A:1 Z�vG
Mailing Address:—P. d • 13oX 43 $ Iin��to�r /V'(2. 2 F 32.'3
T 7
County:_4 la so,,.j-
integrator: - - - Phone:
On Site Representative: Phone:_
Physical Address/Location:
Type of Operation:
Design Capacity: _
DFM Certification
Swine
33(0
Number:
Latitude: 31f ° „E±' 30 "
Poultry Cattle
Number of Animals on Site: '2'9 + e*Soar:S _
ACE DEM Certification Number: ACNEW
Longitude: 71-7 C i6'30"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Q or No Actual Freeboard: Cf Ft. Q inches
Was any seepage observed from the ]a!oon{s)? Yes o No Was any erosion observed? Yes of N�
Is adequate land available for spray? es or No Is the cover crop adequate? es or No
Crop(s) being utilized: tse
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin Oes r No
100 Feet from Wells?'fie 'r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o N)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(S) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:_ Al Ctr. is a %eNetics co.. ie x
Rick" V Reve-]
Inspector Nam
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: /V 0
Facility No.
DIVISION OF ENVIRONMEN'T'AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _T ­_' !j `d , 1995
Time: 9: SO
Farm NamelOwner: AZ Ct r. / /°re - s Z`a a c, f=a r.+•is Z' c
NII
Mailing Address: Ba. 8O.Y 443 S_. IV C. 2 S 3 2_'9
County:
Integrator: Phone:
On Site Representative: Phone: 3 9 y
Physical Address/Location: S ulr+ar h�a ►v.��A ! _ _
Type of Operation
Design Capacity: _
DEM Certification
Swine
33&
Number:
Latitude: 3± 0 4±' 30 "
V Poultry Cattle
Number of Animals on Site: 2 8+ l Bows
ACE DEM Certification Number: ACNEW
Longitude: -79 ° /6' 30 "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (e or No Actual Freeboard: W Ft. o Inches
Was any seepage observed from the la oon(s)? Yes o No Was any erosion observed? Yes o' 1�J`
Is adequate land available far spray? es or No Is the cover crop adequate? es or No
Crop(s) being utilized: Bei F. 0'_ C ra ss
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orQD
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No if Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:_ Al Cfv-, (s a- e&se-tics cam0e x
1-?;cK R e.ve-1s
Inspector Nam
Signature
cc: Facility Assessment Unit Use Attachments if Needed.