090103_INSPECTIONS_20171231

Type of Visit: (a Com liance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: utine 0 Complaint O Follow-up 0 Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: Ci[7 County: ? %o��� Region:
Farm Name: �U=K laaG k (—aV PW IL
Owner Name: JA L) V-1 +k'c- C,4LV- - �r
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q I(
Certified Operator: 'S`t-'►� O
Back-up Operator:
Location of Farm:
�%1t �
jl��
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
190Lf
10
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Pullets
Latitude:
Poults
Owner Email:
Phone:
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?
Phone:
Integrator: y` .e
Certification Number:
Certification Number:
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
eef Stocker
eef Feeder
eef Brood Cow
❑ Yes [3-tZ— ❑ NA ❑ NE
❑ Yes
❑ No
[�]`1QA
❑ NE
[] Yes
❑ No
[3-N-A
❑ NE
❑ Yes [:]No
❑ Yes [2-No
❑ Yes 0-No
E]-9A ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: Date of inspection: OC
Collection & Treatment
_Waste
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�JNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
dNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z/ 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
El"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes E]'No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlicatioo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E✓ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13_ Soil Type(s): C NO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�lo
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[DIN'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D'Ilo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EIFNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[q Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�rNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[l"No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facilitlj Number: cl- [c>4 Date of Inspection: I Wc;t_ f
2j. 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 [ <O
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [9'Rlo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
referato,.questi6i
. 3pY+
_ezp1w situations;{use aifditional''pagc
eo— `-17
16-4--tV N -3 v
_s'V
❑ NA [] NE
D NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes [a -No ❑ NA ❑ NE
❑ Yes EEI No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes [�No ❑ NA D NE
[:]Yes
❑l-4o
❑ NA
❑ NE
❑ Yes
M-No
❑ NA
❑ NE
❑ Yes
�'No
❑ NA
❑ NE
Reviewer/Inspector Name: Phone: ?1 0_33y
ReviewerlInspector Signature: r Date: rp ' Dur Li
Page 3 of 3 21412015

�kS &'6 J�0v tk
Type of Visit: (�,'o/mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: [(� Routine O Complaint 0 Follow-up O Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:�r� Region:r `'
Farm Name: rrl Q&44 9( r4.4 l
Owner Name: 14 P e�� C12 S�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
R_112�C Po —
Certified Operator: �.atwt, �S Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P.onl_
Ca aci
P.o
Nan-Da'try
Farrow to Finish
Layers
I 113cef Stocker
Gilts
Non -La ers
113eef Feeder
Pullets
Beef Brood Cow
Turkeys
,Kars
herM
Turke Poults
er
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [E- o ❑ NA ❑ NE
❑ Yes ❑ No [3-NA ❑ NE
❑ Yes ❑ No [3-NA ❑ NE
[] Yes ❑ No
❑ Yes []'Ro
❑ Yes [:FNo
[]'NA ❑ NE
❑ NA NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

r
Facility umber: 1 - Q jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[c Ne- ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[D-NA-0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-td'b
❑ 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
lI Zo
❑ 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ff r' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Eg-o
❑ .NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes e'Flo ❑ 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 Types): 560
_
13. Soil Type(s): 60 e)C *or %VO - -
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
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ 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
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3"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 E!fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faeffity Number: Cr - Date of Inspection. 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ❑'lTo ❑ 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 Cp'K ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 ""' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes Eq-No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [3 i�o ❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EEI o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
U214o ❑ NA
❑ NE
F .� _ -
Comments (refer toquestion�#) lam anyYESfinsweir"s,andlor any addttlonal recommendations or any-other,cornments.
Idea Arawmac of€ i•eI in:hatt ,A "in cGtnatrnne^[nc Aditi.ii 'naaas_ac_nik�izarvl F _ 13 4M1 �P._ ow
lart — e- c_4 (S
�9
saw
Reviewer/Inspector Name: k Ll
Reviewer/Inspector Signature:
Page 3 of 3
0_e� Vu-30;-AS( -
Phone: C(H 3V
Date:
YAeA
21412015

fj�s �'u N30
ZA
Type of Visit: C�,ommpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason fdr Visit: tJ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4- Arrival Time: Departure Time: County: Region:
Farm Name: ��Owwner Email:
Owner Name: ��-�-� J Y "" `� G.1(i -' hone:
Mailing Address:
Physical Address:
Facility Contact:ltl/ Title:
c4
Onsite Representative:
Certified Operator: S�vt,L ✓mot-y rj
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator
Certification Number:
Certification Number:
Longitude:
Desi n C•urrent Desi
g g
Swine Capacity Pop. Wet Poultry .A Capacity Pop.
Design Current -
Cattle; ry3Capacity Pop.
Wean to Finish La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
p
&R7, W
DairyHeifer
Farrow to Wean
D Cow
Design. Current
I) , P,oultr. Ca -aci P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
HNon-Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke sz
Other
Other
Turke Points
Other
#
_ h a..
Dischar2cs and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
❑'�Ib'
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[ -N-A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[] Yes
❑ No
[I NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
2-KA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
E�J1 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

44
Facifi lumber: - Date of Inspection:
Waste Collection & Treatment
4As storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D K6 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []JIA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Gf
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [2'go ❑ NA ❑ NE
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 En No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rEErNo ❑ 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 0No ❑ 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 [!INo ❑ 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): d 1 e4`w(,-tl.& '56�o
13. Soil Type(s): NCO
CO
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [[] Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [, 31 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F; 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?
Required Records & Documents
❑ Yes E3"No ❑ NA ❑ NE
❑ Yes E3< ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[w]'No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D❑ 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.
I.No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�_,'No
DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E5—No ❑ NA ❑ NE
Page 2 of 3 214.12015 Continued

lFacitity Number: - Date of inspection: A10(%
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RJ-Ko ❑ NA ❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E ° o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
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 [R-116- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes aj' ro ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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?
lam" S, q
Reviewer/Inspector Name: tt� i <<
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes [v]'<o ❑ NA ❑ NE
❑ Yes [;].N5 ❑ NA ❑ NE
❑ Yes [rNNo ❑ NA ❑ NE
❑ Yes 2"No
❑ Yes [f o
❑ Yes [2'!�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�to
Phone:
Date: 1 I""T4_ _
21412015

Type of visa: qp Compliance inspection V operation Review V Structure Evaluation V l echnical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other ( Denied Access
Date of Visit: Arrival Time: f 1 Departure Time: )� County: "y
Farm Name: q r4 Arm) Owner Email:
Owner Name: ��5 Phone:
Mailing Address:
Physical Address:
Facility Contact: _TU'1+�Lam' Title: Phone:
Onsite Representative: tiJ Integrator: r
t t
Certified Operator: �Q.r'il 11° Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: PS4060
Design Current
Swipe Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
15
D , P,oultr
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults.
Other
@_a acit
P.o
Dry Cow
Non-DaiEy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
1111101111
Other
Other IM
:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
❑ No
�d NA
❑ 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?
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Page I of 3 21412014 Continued

f
rFacWty Number: - Date of Inspection: )
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;n No ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No WA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes n 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 F] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j 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 Annlication
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 DriQ ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[)&7K No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
( No
❑ NA
❑ NE
❑ Yes U No ❑ NA ❑ NE
❑Yes �qNo ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tFi No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No LA
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Ds ection: ,5
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 D NA ❑ NE
Ir
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 RM No ❑ NA ❑ NE
❑ Yes go No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [B No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to gneshon #) Explain,any YES answers;and/or•any additional. recommendations
or.; an --th' comments:
.:';
Use drawings offelit3tabetter:eiplainystuatrans use,addition! a esss,recessary)•
"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:u'791`3.
Date: ilk Ll'r
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:�,..._- Departure Time: County: VL4PF4j Region:}
Farm Name: P44HQrvio&- Fa,,r rin Owner Email:
Owner Name: Mf4+ flare ee Phone:
Mailing Address:
Physical Address:
Facility Contact: Ua r-e 4o _ Title:
Onsite Representative:
Certified Operator:'
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: -Prlevlw,�2
Certification Number:
Certification Number:
Longitude:
�` Design Current
_ DesignCurrenf Design Current
S,wne pacity Pop.
Wet Poultry �Cac�ty. Pop. Cattle Capacity Pop.
La er DairyCow
Wean to Finish
Wean to Feeder
on -Layer DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
'Design' Current D Cow
D , P,oul ; Ca aei P,o Non -Dairy
Farrow to Feeder
�ZQ
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow _
Turkeys
Other ;;' -
Turkey Poults
Other
Other
4S.'.":�$�:.kirq. z�...ai-esA�idiERF�Y
-' w].•:..
-- '_i=_..ae:_.w:
_�. - -
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
[]Yes No
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

cility Dumber: /Q_ Date of Inspection:
✓L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[—]No
W NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
/r
Observed Freeboard (in): 37
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)
4. 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 )o No ❑ NA
❑ 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):
l3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
R_eguired Records _& Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 NE
❑ Yes
�Ct] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [50 No ❑ NA ❑ NE
[] Yes [X No ❑ NA [] NE
[3 Yes Ci] No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Y No
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes lj No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fhcili number: 40Date of Ins ection: '}
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
(B No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
77��
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
99
❑ 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
Fq No ❑ NA
❑ NE
❑ Application Yield ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVR P?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question # ) Explain any -YES answers andlor any additional recommendations or;any other coRiments ,
Use drawings of facility to better explain situatlons�(use additional pages as necessary) p`
Reviewer/Inspector Name: 64
Phone: —:3 'coo
Reviewer/Inspector Signature: Te6kW_"_X
Date:
$� 'lZ
_
Page 3 of 3
21412011

i ype or v isit: ap 4:ompuance inspection v vperanon Keview V mructure nvaivanon v i ecnmcai Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: FTT�e Departure Time: County: RWraWRegion:�
1 l
Farm Name: 1'-"Ifk7 f-T W 1 rl(x--V— 1- w rlvx Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: S Title: Phone:
Onsite Representative: Integrator:
Certified Operator: la.,' e Sr—� ` 1,, Certification Number: 0/9 D
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Pnp.
Wet Pqultry
La er
Non -La er
13, Poul
ii�Design
Capacity
Design
Ca aci
Current
Pop.
Current
PLo
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
DairyHeifer
Cow
Non -Dairy
rFeeder
TFeederh
Farrow to Wean
Farrow to Feeder
j
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes bfl No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No �q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes M No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Y No [DNA ❑ NE
of the State other than from a discharge? TT
Page l of 3 21412014 Continued

Faciliby Number: jDate of Inspection: l4 3
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
Strut re 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No r NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
1� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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 Cr p Window ❑ Evidenc of Wind Drift ApplWi ation Outside of Approved Area
12. Crop Type(s): ( I� � 1'7->�S� `�'�/, / _ j' . �
�a
13. Soil Types}:
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?
Required Records & Documents
❑ Yes [� No ❑ NA ❑ NE
[:]Yes (P No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
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
[;0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 rainbrcakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: 75 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6g 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
f 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
10
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
D 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
CQ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[allo
[] NA
❑ NE
Ex lainan YES answers andlor.;an addit,onal recommenrlationsor.an :other commentsw K:
Comments (refer,twquestron ff)� pl Y . Y Y ,
Use drawings of facility to better eiplam+situations.(nse alditional.pages as necessary).:.
_..._ _
• r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ID Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: p County: B ff .A121544 Region: )�QO
Farm Name --�� �- 40—rokock.Fcwm Owner Email:
Owner Name: Q {"� 4"f Y=z Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �ggeves Integrator:
Certified Operator: Certification Number: 1779&
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Curren#
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Curren#
Cattle Capacity Pop.
Dai Cow
Finish
Feeder
o Finish
to Wean
Non -La er
"'
D . Point
Design Curren#
Ca aci P,o ,
Dai Calf
Dai Heifer
D Cow
Non -Dairy
o Feeder
Z
to Finish
E
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
11HOther
urke s
Turke Poults
Discharges and -.Stream 1mRacts
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 F No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

lfacili _ umber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
jjfl No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[2 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
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 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? r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J:p No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift PApplication Outside of Approved Area
12. Crop Type(s): 0045fn t 6'41
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
U9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑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 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 21412011 Continued

Gci1i -lumber: - Q Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes [allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA NE
❑NA ❑NE
❑ NA ❑ NE
® NA [] NE
❑ Yes CM No ❑ NA ❑ NE
❑ Yes [�a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes §D No ❑ NA ❑ NE
[:]Yes No
❑ Yes No
❑ Yes No
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or, anyadditional recommendations or any other comnieats. l -"
Use drawings of facility to better -explain situations (use additionalpages as necessary). . Z_
M 14
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

E
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 3 J Arrival Time: 0 ��p.._ Departure Time: County: abA✓�v Region:
CPO —
Farm Name: Qi M Owner Email:
Owner Name: Mct4 Hardee— Phone:
Mailing Address:
Physical Address:
Facility Contact: Lamb
Title:
Onsite Representative: ��iQ.SLam
Certified Operator:
Back-up Operator:
Phone No:
Integrator: S
�re �
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = " Longitude: = o =' = u
ineCapacity
Design Current
Population
Design Current Design Current
Wet Ponitry CapacitPoulation Cattle C►aacity Populaton
Wean to Finish
❑ La er
❑ Da' Cow
Wean to Feeder
Feeder to Finish
[EHFarrow to Wean
❑ Non -La er
Dry poultry
❑ Layers
❑ Non -Layers
❑ Da' Calf I
❑ Da' Heifer
❑ D Cow
Farrow to Feeder
❑ Farrow to'Finish
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
El Pullets
❑ Turkeys
❑ Boars
❑ Beef Brood Co
i ther
Number of Structures:
❑ Turkey Poults
❑ Other
❑ 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?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
K)No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection I' '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Stru tune 1 Structure 2 Structure 3 Structure 4 Structure 5 S cture 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4 s
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 ElNA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
53 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
le No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Comments {refer to question a#} Ekplain any YES answers and/ r any recamme�ndat ors or any, otli€er comments.
erexpan dpaU&e dravangsofacthtte*t;ges,as�necessary)
R (-2-9 If 0
Reviewer/ins pector Name ` °' ;� x Phone: �rL1'" i �3-ZU
Reviewer/Inspector Signature: Date: 9i'36I1,0
Page 2 of 3 12128104 Continued

r •.
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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
M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
❑ 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
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[O No
El 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
[53 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
171 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
§9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EP No
❑ NA
❑ NE
Additional Comments and/or Drawings: . - # A
Page 3 of 3 12128104

j
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ] Arrival Time: r,cO &!- Departure Time: County: 1APv Region: �FO
Farm Name: o ��[�- �f Owner Email:
Owner Name: f ' a4+ gai ec Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Vg* �; Operator Certification Number: 17296
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= e Q ' ❑ Longitude: 0 ° = ' ❑
Desig I C•nrrent
Design Current
Design Cnrrent
�Sv"sine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Da' Cow
❑ Wean to Feeder
❑Non -Layer
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
La
❑ ers
❑ Da' Heifer
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ No ers
❑Beef Stocker
❑ Gilts
El Beef Feeder
'
❑Boars
lets
❑Pullts
❑ Turke s
Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other I I
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
1p] 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
EfNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

N
Facility Number: Z1 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure l Stricture 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in): 3;pf
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [Pio
❑ NA ❑ NE
❑ Yes ❑ No
r3ONA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes rem
No
❑ Yes ?!I No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [!�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes q5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop
13. Soil t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�i No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
45 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ yes
T No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: Q7
Reviewer/Inspector Signature: Date: 94
12(28/04 Continued

11
Facility Number: — 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Desigm El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C�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
11 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
42No
❑ NA
❑ NE
E
Page 3 of 3 12128104

Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I If
Date of Visit: I EY2710BArrival Time: 3.10 0" Departure Time: {l: r, County: BLAI�t _N Region: IOW
Farm Name: f N1 & Owner Email:
Owner Name: ee Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: prey
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= ` Longitude: = 0 0 I ❑ "
Design Current
Design Current
Design Current
acity Population
Wet Poultry Capacity Pop�lati©n
Cattle Capacity Population
an to Finish
fED—Feeder
❑ La erP
❑ Dai Cow
an to Feeder
❑ Non -La er
❑ Dai Calf
to Finish
❑ DairyHeifer
Farrow to Wean
. Po❑
D Cow
Farrow to Feeder
246
t0
ers❑
❑ Non-Dairyr[E-1
Beef Stocker
Farrow to Finish
ers
ru
❑ Beef Feeder
Giltson-La
llets
❑ Turke s
Boars
❑ Beef Brood Co
- _ - -
-
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: EEI
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
19 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D9 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
DkNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
tallo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
to No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — o3 Date of Inspection �1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes )a No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IR 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
INo
ElNA
[INE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(% No
[I NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA
❑ NE
maintenance/improvement?
1 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 8 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 ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CaR$lI n+ q-�s�). Sr,. cz.4. ©t,� �l� ly►� +^ ?A�! i SA+�
13. Soil type(s) F U'M "r?cA I c-,v IdSbe-ty , �`p!',�OI�L 646 Ala?5
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[9 No ❑ NA ❑ NE
C0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commentsi r }�
Use drawings of facility:to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name 5 Phone: D� 3= ��
Reviewer/inspector Signature:
Page 2 of 3
Date:
12128104 Continued

r
Facility Number: q— Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'ANo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes "GNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes n 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
P No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Jf�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V?No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
'P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JP No
❑ NA
❑ NE
AddidQRal Comments aridldry Dray .
Page 3 of 3 12129104

f--
0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
_._
Other Agency -
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Ja
07 Arrival Time: � Departure Time: County: .C�Q� Region:'
Farm Name:m F �Owner Email:
Owner Name: f `�Q IV1 Phone:
Mailing Address:
Physical Address:
Facility Contact:_ Title: Phone No:
Onsite Representative: Integrator: �t1°S'77Y[
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 { = N Longitude: = 0 0 ` = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design — Current
Capacity Population Wet Poultry .. Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
luTurkey 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 Populatr&
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ pnrcow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: [T]C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes %No ❑ NA ❑ NE
❑ Yes
❑ No
DNA
❑ NE
❑ Yes
❑ No
CI'NA
❑ NE
[ tNA
❑ NE
❑ Yes
❑ No
❑ Yes
[�.No
❑ NA
❑ NE
❑ Yes
'�'No
❑ NA
❑ NE
12128104 Continued

o- Z
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ElNE
S ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[� No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
L
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0 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
r No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P�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
MNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
( No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)^+''►4�,-�
�+f�• .inzr� �
13. Soil type(s)
M0
r 1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
` 9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
yes
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yeso
ro
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OPNo
❑ 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 WW1 8 Phone M O V23-33!�O
Reviewer/inspector Signature:1-129&Date: IWO
12128104 Continued

iL
Facility Number: — 031 Date of inspection f I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi gn El Maps ❑Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
.n No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ( No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes P No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
§allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F 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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
e
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
%No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�Vo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

11,
sauali[ I __ ___ _[7_EFacility Number%C� Dsion of oiland Water Conservation
----�-- �— Q Oer Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit W14outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure
[lTrime: ET
Farm Name: OCk—fit/
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
&.n f464 -
I - U
Certified Operator:
Back-up Operator:
County:
Owner Email:
Phone:
No:
Integrator:
Operator Certification Number:;
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 1 = u Longitude: 0 ° = ' a u
Current Design
C+urrent Design Current
ne Capacity Population Wet Poultry Capacity
Population Cattle C►apacI Population
ai Cow
❑Dai Calf
❑Dai Heifer
❑ Dry Cow
rDesign
to Finish
❑ La er
❑ Non -La er
to Feeder
tv Finish
r
Dry Poultry
to Wean
! z
B6fMffow to Feeder
❑ Layers
❑ Non-Dai
❑ Farrow to Finish
Non -La ers
❑ Beef Stacker
El Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Cowl I
Other
Number of Structures:
❑ Turkey Pouets
❑ Other
❑ Other
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
❑ Yes
,�/
52No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Ok�A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
0 CIA
❑ 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)
El Yes
El No
,�,
U'NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yeso
;/N
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number — 6
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 'LEI No ❑ NA ❑ NE
❑ Yes ❑ No U'KA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in): ,,,,_,,�
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes IL�J'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 To ❑ 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 4vo
❑ 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
Ll No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,,��,,!!
2<o
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
y�lo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windrow_- ❑ Eviid�e�nce of/Wind
� Drift ❑ Application Outside of Area I
+ -,�� ,,n�12. Crop types) & rn u � Q ��l G ✓ `� S ` t c�-C�t1Y �S ►'b W Y�
13.
Soil type(s) P MOL _lam�1,0
U , U
J
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EKNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ICI No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[Ro<o
❑ NA
❑ NE
Comments refer to question y y y ( q #): Explain an YES answers�andlor an recommendations or an other commen
Use drawings of facility to better explain situations: (use additional pages as necessary): 4 ts
Reviewer/Inspector Signature: Date:
rage a of .s 1L1L5/u4 c onrtnuea

Facility Number: — 03 Date of Inspection '
Required Records & Documents ,�,_,,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L4 4 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ElM Yes o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
91�0
❑ 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
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,�No
ll�' No
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
2NN/o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0<0
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R<o
❑ NA
❑ NE
Other Issues
28. Were anv additional oroblems noted which cause non-comnliance of the Dermit or CAWMP? ❑ Yes Ek<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U€o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O/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?
El Yes
,,�
P N
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
Na
❑ NA
❑ NE
Additional Comments andlar Drawings. .
t
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: y .2 QS Arrival Time: oC •'yam Departure Time: County: jQ�e� Region: KO
Farm name: -- Owner Email:
Owner Name: P,-e s A d a cJ exr aQcp _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:4-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Pr<�a_�
Operator Certification Number:
Back-up Certification Number:
1-7'794
Latitude: = c 0 I = 1
1 Longitude: = o = 6 =
64
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Populatiou
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder I a L4 R/
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - --- - - - J
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ DaiEy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F,T
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?
E
I
❑ Yes (9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
i
12128104 Continued

Facility Number: — /D
Date of Inspection 16 !e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
J
Identifier:
Spillway?:
Designed Freeboard (in): 1' /�% // /a`1 / iix
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FXI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
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
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r mu �a j�a 0-5
13. Soil type(s) fir_ LV« �,e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[21 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
ReY+loJC 0-5 +o P Gacw� o�aw.agC �c� "?cr1�Lw�2 CY0j0
[ 1
C �.1�1n 1 aP GQ% i V (� +c� �j c� V- c. P1. T11
da+� has Pcc�-i-•
Reviewer/Inspector Name j /SQ / Phone:
Reviewer/Inspector Signature: Date: G 16;r-
12/28/04 Continued

Facility Number: q— Q3 Date of Inspection u /�
RequircAecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the apj�ropriate box below. ❑ Yes [� No ❑ NA El NE
/. /
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Otherlssues
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
B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12128104

Facility Number Date of Visit: '3 " Time: ! T
Q Not Operational Q Below Threshold
M'Permi#ted 0 Certified © Conditionally Certified Registered Date Last Operated or Above Threshold:
Farm Name: ----- -. NGM Noe le Far-'n__---- - -- County: 1*rkn,.»., "' U
Owner Name: ! "1F1 ....�...._. Phone No:
Mailing Address: _3 01 /�� a�C- _�Or, rfL //'w /V 6 � $ 3 3?
Facility Contact: — If ama e Barc, fA2P± _ . Title: Phone No: -- ('i1 S 9..2.- --5-7�I l
Onsite Representative: ,L�cirr a� Integrator. enzi&o
Certified Operator. �� N�a r Operator Certification Number.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude 0 Du
Disch e$ & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [40
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0'�io
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yeso
c. If discharge is observed, what is the estimated flow in gaYmin? r�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Ergo'
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q'No
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q'go
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ell�o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ! "
12/12/03 X B Continued

Facility Number: q .-103 Date of Inspection -CJ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [a Yes 01�0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes gf' 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 [�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes D'Igo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2r9o'
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes ONO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [3No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &r,.ati�a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑W O
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are their, any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes QFIo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ®'No
Air Quality representative immediately.
answers sumd/ar �Y.. or-
b older
s
[3se dra�vmgs of_ tzTity to bested_ samsrons. (tee EjVireld Copy ❑Final Notes
C
/ar»1 r S �v..+r�.� Rne� �trw�n9 kvgs�ewu7r is P-�j 4o�edn
Ulas A7L Zo �', 'Please keelo 4 reca.Gl
Irahs fPrPPcl,
I/4A 4crwe i eem � /o d�Gf /►ror� �Gq� / a Zva f le to 4,,, ,
-n - '-$'^ -
Reviewer/Inspector Name x=�ra
Reviewer/Inspector Signature: Date: ? - G
12112103 Coked

a�
Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewerilnspector fail to discuss reviewCmspeckion with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any addition problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 0 Pit'
❑ Yes p-No-
❑ Yes OW
❑ Yes ErNo
❑ Yes O lTo
❑ Yes CMo
❑ Yes BlVo'
❑ Yes Q No
❑ Yes ago
[- —es ❑ No
❑ Yes Bwo
❑ Yes allo
❑ Yes Gizo-
❑ Yes am-
❑ Yes [1No
12112103

Site Requires Immediate Attention: hj 0
Facility No. O 9 - /03
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 , 1995
Time: t Z 5_�
wt Nock
Farm Name/Owner: A p��km-���o z „r�
Mailing Address:_ Po. I3� ism c%,Qti. t�{o4.,v NC 28337
County: 3/0 J� •�/
Integrator: Pre s t* f �=A► ,...s -TV c Phone: /O S"9Z - s 7 7
On Site Representative: load 4 Mz vd c t- Phone: i9lo) 0 3 IV
Physical Address/Location:_ SR i 7/0
4
Type of Operation: Swine
Design Capacity: ` t .
DEM Certification Number:
Latitude: 0-
Does the Animal Waste
Poultry Cattle
Number of Animals on Site: t z, ysue,
ACE DEM Certification Number: ACNEW
Longitude: '
Circle Yes or No
Lagoon hav sufficient freeboard of 1 Frv,r .i is nA L____
(approximately 1 Foot + 7 inches) (Yebr No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? (F)Dr No
Crop(s) being utilized: C )
Actual Freeboard:- 2 Ft. Inches
storm event
Yes or NWas any erosion observed? Yes or 0
Is the cover crop adequate? YeSor No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? �e or No
100 Feet from Wells? eor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or� 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) Ye r No ,F--
Additional Comments:
'Q
/T/V`(,e 2 /G
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

MORT13 CAROLINA DEPARTMM7T OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DMSION OF ENVIRONMENTAL MANAGEICMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
zm .:, < ` '_ iNtSgECTION , DBT . ;�..: FARM. I�ILIKSSft =' ,
Flack F ym L& ItOf- I ku'-*c CCcu e 1-bIkl
'yam
'..lYfII+I �,.ADDRESS","E�YFACILIii %YIUi BER
�oX (��r- �(izC�L tl�t�iti'��,N 2�'���� C� IC,- 245-(ob34
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Anima' Operation Type:
Horses, cattle, �wine,
SECTION II
Romwin9 (148)
poultry, or sheep
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)] .
2, Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIFIED -ANIMAL
WASTE MANAGEN124T PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimun
setback criteria for neighboring houses,
wells, etc?
Y I N I COMMENTS
i2ECEIYEA
JU 31 199.;
rNV 'iiiANAGEMENT
iMETTEViLLE REG. OfffCg

58G'lIEII� IIY
yield ,bite_ Management
I. Is animal waste stockpiled or lagoon
construction withia 100 it. of a USGS
May Blue Line Stream?
2. Is animal Waste land applied or spray
irrigated within 25 ft. of a Was leap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION p3J►rT?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
fa= adhere to Best Management Practices
(BMP) of the approved gffl FICATIUN?
7. Does animal Waste lagoon have sufficient
freeboard? How much'. (Approximately )
S. Is the general condition of this CAFG facility,
including management and operation,
satisfactory?
SBGTION TV
Comments

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DIRECTIONS -TO HAM HOCK FARM
So �
From Clinto1. .n take-70utjj to Elizabethtown
go through town and. tu=n left_ at'Mcbonalds
onto :Mercer Road (SR ' 1700.".�"' Go. 5 '3/4 miles
turn left onto EIktO'n, Road '(SR1710) Go
through 2 cross roads '(171i'_&­1760) Farm
is 5.1 miles on right.—

?GIST?-kT:CN FORM =CR ANIMAL - =L07
Department of Environment, liealch and Natural Resources
Civision of Environmental Management
Water Quality Sect cn
If .te 'a.n imal waste management system for- your feedlot cwe=a icn is
designed to ser•te more than or equal to in head o: c2.tt e, 75
horses, 250 sw-One, 1,000 saeez, or 30,000 birds =nat are served by
a __quid waste system, t en t."._s 3c_:a m,;st !:e cu-- and :tailed
cy De_e:ri::er 3:; _993 pu_sua_^.t _.A NCAC 2 .0_7 {cy '_n crtec tc !:e
,deemed Permitted !:v O `"_. °_ease prizz c,ea_iy.
-z zm Name:
Mall_^c Adc_ess .
CcUn t v :
Cwner(s) Name:
Manace= (s) Nam. e
lessee Name:
--arm Location (tee as spec_'_c as possible: read na-mes, direction,
Milepost, "C.) : -fv - -v
f <�� r'7/0 ) U." - Fl. A. 4 2W- P 4� ) i 7-4ao rr`
gat=tulle/Long;te ,f kncwn6e
Desic:: capacicy of ar.i:t:a'_ waste management s stom (Number and type
cf c�r.fi::ed ar._::a_ (s)) i 1�$ 5n� f-0 F�caeR
Averace anima'_ ccnulation or. t`ie fA= (Number and tune of animal(S)
raised) : M a•`t�2�. S �r-r�� 52 2 0 eX
Year Production 5e4;an: tgGt % ASCS Tract No.
Type cf waste Management System Used:� c - .-•-��( r2.� _ _� --�
Acres Available for Land Application of waste: 2�'C> NC -
Owner (s) Signature(s)