090186_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

&A-6
t ype of visit: Wluompttance inspection U uperatnon Review U structure Evaluation U I eennical Assistance I
Reason for Visit: @1 routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q S Departure Time: D .1 7K County: J
Farm Name: �L�Y� ��Gt�/���,�y..-� Owner Email:
Owner Name: q t 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: &4tS -E 4W tC�_' Title: Phone:
Onsite Representative: Integrator:
Certified Operator: ��!` 'Z_>%V lS Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: C2&Q_
Current Design Current Design Current
Caacyo.eoultry Capacity Pap. Cattle Capacity Pop.
rDesign
ish La er Dai Cow
1!
eder
Eeeder
Non La er
Dai Calf
DairyHeifer
nish
p =
Farrow to WeanE#r„��
Design Current
aci Pao .
Dry Cow
Farrow to Feeder
-Dairy
Farrow to Finish
ILayers
I
113cef Stocker
113eef Feeder
Gilts
=
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 2< ❑ NA ❑ NE
❑ Yes [] No
[:]Yes [:]No
[k<A ❑NE
[g-< ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [-]No E],K( ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facilfty Number: - Date of Inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats stto`the �integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
E]rNo ❑ NA [] NE
❑No 5j-N7C_ ❑NE
Structure 6
❑ Yes �io ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Quo
❑ 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
NK
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g►Nlo'
❑ 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
Ijjn'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 [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 ❑ EEvidence of LWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): — �y'r`t, f`."' — 1 --
13. Soil Type(s)
01N'k"tL I 011 -
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?
❑ Yes
R1 o
❑ Yes
12►Ko
❑ Yes
[ o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Qo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FrNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E9014o
❑ 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
Ig,?1P
❑ 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
Vo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[—]No
ET A ❑ NE
Page 2 of 3
21412011 Continued

Facilfty Number: ID2te of Inspection:
c 24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes ['1�Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [B-Tqo'_ [] 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 To ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes D-o ❑ NA ❑ NE
❑ Yes 0'< ❑ NA ❑ NE
❑ Yes EDX6 ❑ NA ❑ NE
[]Yes CD.M ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑-Noo' ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L .Woo' ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes 0,110 [ NA ❑ NE
Clommen#s (refer to question;#)Eaplam any YES answers and/or any additional recommendations or_any othericomments.
Tse draw�igsof facility to better,-eirplatn situations (use additional pages. as necessary)
Vo exin 6n'�
� ss� W-C--e ks L e s
Q�w5wcv'
Reviewer/]nspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date: 6 a
/41120

IYPe or visit 49 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: •,]�O,r Arrival Time: O Departure Time: County: Q14d/r2 Region: a�b
Farm Name: Owner Email:
Owner Name: Rum v _ F�Yrn/n,G, _ Phone:
Mailing Address: T
Physical Address:
Facility Contact:
Onsite Representative: 16A1y frreala
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator: A-&. j- .g4
Operator Certification Number:
Back-up Certification Number:
Latitude: = I = a Longitude: = e
a
Y S] y^ "� s, w t h
�, t k g .� + r rr�
DestgnF- r '
}'w r s Destga =. Current = : k ,,��t Current
a :~ f
Cilrrellt
; ,.,, t DesfgnRd;-
5�vine� f p Capacity Population
Wet Poultryr > Capactty;`Popvlatton
.Cattle " : °F; , Capacxtyy Population
_
G; can
Layer
E
❑Non -La et
Dry Poultiy
��._ �� *•;;�a`� ,_,.. „e
❑ La ers
y
k
❑ Nan- a ers
s
❑ Pullets
YA
❑Turke s
`'
cJ, '
: ❑ Turke Pouets
❑ Other
❑ Other
Numt�er of; Structures «,
w
to Finish
�
u.
-
-
Wean to Feeder
�eeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow i0 Finish
El Gilts
Boars
Discharges 8 Stream III1P8Ct5
i . is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D COW
El Non -Dairy '
❑Beef 5tocket
❑ Beef Feeder
❑Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
` "other than from a discharge?
❑Yes DNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
El No
❑ Yes
M No
❑ NA
❑ NE
❑Yes
[3'<o
El NA
❑NE
I2/28/04 Continued

J
Facility Number: — �! Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: �p
Designed Freeboard (in):
Observed Freeboard (in):?
❑ Yes BNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E '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? 911es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [allo ❑ 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 9"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes ["Io ❑ NA El NE
maintenance/improvement?
11. is there evidence of incorrect application? - If yes, check the appropriate box below. ❑ Yes 2<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I UTA or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area '
12. Crop type(s) AZArri-�(
13. Soil type(s) _No,�UJ---
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
EN
❑ NA
❑ NF
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination`s] Yes
❑ No
❑ NA
EJU
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[2'9
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2-f,< o
❑ NA
❑ N
P&sc work 4V a ,rid yrasS Gdvef pr dare arras o{ l6goon parlhs 16 poeevav,7
le rOs: A.
please dr-SPdS[ Of ot!/ -�cec�( ;n cc •y��+r►f�,cA
Reviewer/Inspector Name`I%%r Phone: !Ila
Reviewer/inspector Signature: / „�- _ _ -- — Date: 3-.2 ;)-y5-
2128104 Continued

r
Facility Number: — G Date of Inspection
Reg uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 21es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER -No ❑ NA ❑ NE
the appropirate box. ❑ W ❑ ChecWtts ❑ De,%6 ❑ Mp<' ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
R.<Kaste Application [R<eekly Freeboard [3<aste Analysis ❑;sailxsaips7s ❑ ❑ e
[ infall ❑.Stodtimg [" Crop Yield 120 Minute Inspections [ Monthly and V Rain Inspections [ Bather Code
22. Did the facility fail to install and'maintain a rain gauge?
,9,fes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E3 Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
52,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El -No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2,&o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
9-NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D 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
0-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
E 1Vo
❑ 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
[� Vo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[;Ko
❑ NA
❑ NE
19. P/caw 11a<< a OF 7 p CerT�ar'aa{C f �o�.rragc �,� i«'171 6111# Fcr,.,
rccorals,
71, ems,; i/tcsr
leeP � �e
GWelel free 6o.�d wa
r
k
1
e
co.o/s `� c•A' ry
4"
f
please "U/. /
c. rp;n guwye near
'die /45C-0n
P str7 (I�br.��
Alr
Ww3T-� B[/.briC q�:b� �i/Ii'i
Y please p4ce a
e_� of 04C . M
C104A r q Feri.n rCGolcls
c - Please p /a« a cow, .f :lam 9 tc o�
o% t s t7, in rn � .15
12128104

i
i ype of Visit 123tCompliance Inspection U Operation Review C1J'Structure Evaluation ,,.U�Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency tether ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: D_
Farm Name: J&±n6 �22r�w 1 � �o/+�- Owner Email:
Owner Name: 4 ?. r) ✓�-Phone:
Mailing Address:
Physical Address:
Facility Contact: .< "�-�.s _ Title: wYL Phone No:
Onsite Representative: Integrator: S:i__ % —_
4
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 P ET 0" Longitude: 0 e= 1
Design Current
Swine Capacity Population
Design
Wet Poultry C►apacity
Current Design C+urren#
Population Cattle C►apacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cory
❑ Non -Dal
El Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Wean to Finish 1
10 Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish QI
❑ Farrow to Wean
Dry Poultry
El Layers
❑Non -La Non -Layers
El
❑ Pullets
❑ Turkeys
[Ell urkey Poults
❑ Farrow to Feeder
❑ Farrow to Finish
10Gilts
❑ Boars
Other
❑ Other
10 Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Cf— Date of Inspection
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
J.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?
MYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E .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
[9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C,No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RlNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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
ELNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
13 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
r No
❑ NA ❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EgNo
❑ NA ❑ NE
AIL
415 row w�IlGi Q rJ D �� p
ReviewerllnspectarName�
_
:;Y , �, Phone:j�
Reviewer/inspector Signature:
Date:
0
Page 2 of J I L/L6/V1/ • v++ssnuc�s

(V Facility Number: — Date of Inspection
I Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RLNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;?INo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M.No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�qNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,BNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
allo
❑ 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
$allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O.No
❑ NA
❑ NE
12128104

.I
Type of VisitC,,,,ommp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9<00utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'Time: Departure Time: County: ' Region:
Farm Name: 0,4 4D a/i S r/7'Lr Owner Email:
Owner Name: _ __ C) 06y i S __ Phone:
Mailing Address:
Physical Address:
Facility Contact: , Title:
Onsite Representative:Cl
Certified Operator:
Back-up Operator:
Phone No:
Integrator: —/22 g"
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 00 ❑' =« Longitude: =0 0 i =
As
Design Current
. ��
Destgn f�Current
Design
Current
Swine Capacity Population
Wet Poultry
CapatyP,opulation
Cattle Capacity
Population
❑ can to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish n0 O a
` x`<:
N .� ...
El Dairy Heifer
❑Farrow to Wean
Dn Poult❑
irl
r
D Cow
El Farrow to Feeder
El Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other -
El urkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part oi'the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [ONo ❑ NA ❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
QNo
❑ NA
❑ NE
12128104 Continued

f
Facility Number: — Date of Inspection '710�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C,No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [:]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNo ❑ 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 E 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
D.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo "
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[SNo
❑ 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
rO No
El NA
El 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
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C.No
❑ NA
❑ NE
Additional Comrtients"anillor D"rawings: 7..:
Page 3 of 3 12128104

Facility Number: — Date of InspectionC� D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IR No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
CRNo
❑ 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
El No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JKNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) a,, /�f/,/a+B�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9No
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or an},other comments:"
Use drawings of facility to better explain situations. (use additional pages as necesslik)
U
Reviewer/Inspector Name Phone:
�— 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 - / 17/7R/nQ Continued

r
Facility Number o q 1 $(a
WDivision of Water Quality
0 Division of Soil and Water Conservation
0 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: Arrival Time: : 14C ; Departure Time: 2 : o na County: Region: FR.a
Farm Name: T-oNA,ld Aar►— } �rw• _ Owner Email:
Owner Name: R-+J 4 bt"J 5 Sir . Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: u SPtic�%s� Phone No:
Onsite Representative: G'��'� Moor-,__ integrator: M u +'A 6
Certified Operator: �e 1-6r a Abbs Operator Certification Number: 7—
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =1e =' =" Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouets
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
p = c [� w
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daior Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[P No
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

m
}

Facility Number: D — /g Date of Inspection I2 -13707
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[A No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in): t 6r, S7
Observed Freeboard (in): _ 3 tZ .
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [0No ❑ 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 Aoolicatian
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [A 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 l 0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �ornt �. S� 4 be_"S _
13. Soil type(s) 14c,,-A[[� Galo�s �aro
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes 10 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 [A No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question ft 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 }ZiL RQ jCAS
,., Reviewer/Inspector Signature: a.J& Z——
Phone: 910 , V33. 3360
Date: 1 Z ~ 13 - z_o6 i
12128104 Continued

Facility Number: Q 9 — jr& Date of Inspection
Re uired 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 El Design El Maps ❑Other
21. Does record keeping need improvement? If.yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
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
l 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

K
Type of Visit ®'Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Fallow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: / � Arrival Time: : O D Departure Time: County: hct Region: F D
Farm Name: _ D/"L aw; S Gt 0' Owner Email:
Owner Name: R 0 ► i_ J` oy i 5 _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Z 12n. D:q,1 . S Title: Phone No:
Onsite Representative: �f}dYY Integrator: Znalc/ 1
Certified Operator: �B""�— ��% S Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o u Longitude: ED ° 0 I ❑ "
. .M
Design C*urrent
Swine C*apacity Population Wet Poultry
Design=.'Currentm _ Design Current
C►apacity Pap;ulatton.. CattleWEapacity Popuiatian
❑ DairyCow
❑ DairyCalf
_ - = ❑ Dairy Heifer
r ❑ D Cow
❑Non -Dairy
f' El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
to Finish
❑ Layer
to Feeder
-Layer
r to Finish t� 3�"O
to Wean Dry Poultry
w to Feeder
to Finish
RE
❑ La ers
�
` ❑Non -La ers
•. El Pullets
❑Turke s
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
i§d No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facitity Number: — Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WU, ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfaIl ❑ 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 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
f R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
O 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
0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
12129104

Facility Number: — b Date of Inspection
Waste Collection & Treatment
*' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
JQ Yes
IWNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
eer:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
V;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
24 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
[UNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
t
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�R No ❑ NA
❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R'No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) WIf fay
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
�No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CaNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
KNo
❑ NA
❑ NE
IT 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
g No
❑ NA
❑ NE
Reviewer/Ins ector Name :s R E" s �J�-�1133y O
p D'-- <r.. Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

I
(Type of Visit 4Mompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Koutine O Complaint O Follow up o Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /�� I -PC z � D
y� f D Arrival Time: Departure Time: ,� c7 County. Region:
Farm Name: r��! u" 5 �.s,�� Owner Email:
Owner Name: S� �'t D�tli 5 Phone:
Mailing Address: - L •WLr— (-D4 . (_-L' ��r
Physical Address:
Facility Contact: R a,^ DCLLI4_ _ Title:
Onsite Representative:
Certified Operator:'+
Back-up Operator:
Phone No: 9/0
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = « Longitude: = o = , = «
Design Current Design Current Design
Capacity Population Wet Poultry Capacity Population C*attle Capacity
Current
Population
an to Finish
❑ Layer
El Dairy Caw
an to Feeder110
Non -Layer
❑ Dairy Calf
eder to Finish
tEO]Farrowto Wean
row to Feeder
p 3
_
ultry
La ers❑
Non -La ers❑
El Dairy Heifer
❑ D Cow
❑ Non -Dairy
row to Finish
Beef Stocker
ts
Beef Feeder
❑ Beef Brood Co❑
ars
Pullets❑
Turke s ❑ Turke Pouetser ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 [&N0 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

r
Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(iel 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?
[2 Yes
❑ No
❑ NA
❑ NE
S. 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
EgNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CgNo
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Rio ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) C r
13.
Soil type(s) _��6 jk
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
5�No ❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement? ❑ Yes
[RNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
�& No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
QNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
ice' No ❑ NA
❑ NE
l s,::' /D_-'IV .' NPc'4 `ro . e P:1-)_(,d (S7_4,S Ate-rASTo
Reviewer/Inspector Name _ l Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection f ��
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ 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 ❑ 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 Cl 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
0 No.
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E 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
tKNo
❑ NA
❑ NE
Other lssues
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
UNo
❑ 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
JKNo
❑ 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
MNo
❑ 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
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
K-Yes
,ERNo
IJl�fiio
❑ NA
❑ NE
__�7 11o0 d dw eQ' &z4- / 0- / -v2o10 -'1- 74' �- jpo,t—, Uu 0 rh 0-' to-
t
12128104

type or visa: kjx-otnpuance inspection V etperanon Keview V structure Lvatuatton V i ecnntcat Assisrance
Reason for Visit: Q�Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I-1 I ON Arrival Time: Departure Time: County:
Farm Name: E £ ak �,M3 iu,g Kl? QS Owner Email:
Owner Name: �frrtntl f1 �D Rrx� K �'faR�g LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: CL few QI", Title: Phone:
Region: F46
Onsite Representative:
aap(\ 0
Integrator: �ttQip
a7F{ow�
Certified Operator: Gwkg
_sa��C--,
Certification Number:
g 1 i Cl
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
C•ut rent
Swine
Capacity Pap.
Wet Poniti-y
Capacity
Pop.
Cattle Capacity
Pop,
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
3a00 t O0
"'
°`
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr,1'ouifry
Ca aci
P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Pouets
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
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 [V11lo ❑ NA ❑ NE
❑ Yes ❑ No [JNA ❑ NE
❑ Yes ❑ No [YIA ❑ NE
❑ Yes
❑ No
❑ Yes
[aj�o
❑ Yes
ER"No
Cg-NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: -j Date of Inspection: 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: -HIZ
Spillway?:
Structure 3 Structure 4 Structure 5
[]'To ❑ NA ❑ NE
❑ No [j2"NA ❑ NE
Structure 6
Designed Freeboard (in): 19
Observed Freeboard (in): 61u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EVNo
❑ 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
CD,,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ETNo
❑ 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
EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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): 0--oRn . 1,-3hLAV. V'4 pnS
13. Soil Type(s): SIpGg- 0
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 [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E�fNo ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes allo ❑ NA ❑ NE
[:]Yes [9'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [E(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 [5No
❑ 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 ff 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
B'�A ❑ NE
Page 2 of 3 21412011 Continued

L
Facili Number: - j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
[j?"No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check
[:]Yes
[�rNo
❑ 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
[g"No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
MNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes G2"No ❑ NA ❑ NE
0 Yes EfNo ❑ NA ❑ NE
❑ Yes []rNo ❑ NA ❑ NE
❑ Yes [E�No ❑ NA ❑ NE
❑ Yes Ej No
❑ Yes [EfNo
❑ Yes RfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer.to question #) Explain any. YES:answers and/or any addrtionai�recomimendattons`or:any'6-ther coiiiii eats.
Use drawings of facility to better explain situations (use additional pages as necessary,): f _. _;
Reviewer/inspector Name:
Reviewer/[nspector Signature:
Page 3 of 3
Phone: �ttCl'�og.[z6u�
Date: 'V�lA 1�
21412011

0 Division of Water Quality -
. _ . - :•._ Q.Division of SoihandWater-Conservation >:
0 Other Agency = _
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Beason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Q !fate of Visit: Tnne: ''3( Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
® Permitted ® Certified [3 Conditionally Certified 13 Registered Date, Last Operated or Above Threshold: .................
Farm Name: .. il.✓ �d. J.QL�l., ....-+................................ County:.....� ...........................................................
Owner Name: ................. Phone No:...L.���....`�Pp.y�9.............
Facility Contact:-�,�Ae....... Title: ............... Phone No:...................................................
...............
Bailing Address: ........ ��1''�"". .!'� .....d` /%............
2/
Y.............................. ... . .......... .........
Onsite Representative:......... RIO.✓'s'�� ��/� Integrator:......... � "� �..�
.........
................................
Certified Operator:,,,,,---�7s�T C� ICJ Operator Certification Number: ......................................... .
Location of Farm. -
[I Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C�6 = Longitude • ' "
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer I 1 ❑Dairy
Feeder to Finish 247&1 24 6 JE1 Non -Layer I I[I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
tEE
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag—n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste !Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 29 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes KNo
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) 0 Yes allo
c. 11" discharge is observed. what is the estimated flow in gal/rein?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [?rNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E No
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:.......................................................................................................................................................................................................................
Freeboard finchca):
5100 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes OXNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes (:No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes $2 No
Waste A112lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
11. Is there evidence of over application? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload ❑ Yes krNo
12. Crop type C.,u /iiB.Q.rJ � APeZ of s-,4,f- , Al,
13. Do the receiving crops differ wittrthose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
Wo
c)'This facility is pended for a wettable acre determination?
❑ Yes
;RNo
15. Does the receiving crop need improvement?
XYes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
ji�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VINo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
CkNo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X[No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21. Did the facility fail to have a actively certified operator in charge'?
El Yes
CoN
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
ElYes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
CKNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ANo
violatFgtis:or ilefciencies mere itQte. dirrtrigthis:visit; Yoir will receive �iti further
• corres oriderrce:a�' f this :visit. ::::::::::::::::: :::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
`p
dry ! iiy ' tins
qV
Reviewer/Inspector Name
Reviewer/inspector Signature: �J� ��«jam Date: 5100

Facility Number: Date of Inspection
Odor Issues
26_
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
�](es
❑ No
liquid level of lagoon or storage pond with no agitation?
!! ��
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
OVo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�$No
30_
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc_)
❑ Yes
FNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Wo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
WNo
3123/99

Q Division of Soil:
a Division of Soil
�r
Division of Wati
Routine 0 Complaint O Follow-up of
Facility Number p
ration 'Operation Review
ahon .Compliance Inspection, ___=pn�
action 0 Follow-up of DSWC review O Other
Date of Inspection 1
Time of Inspection I 1_,,,$a 124 hr. (hh:mm)
0 Permitted 0 Certified 0 Conditionally Certified [3 Registered E3 Not O erational Date Last Operated:
Farm Name: IiOY a....0G 65... ramc":: County' p .......................
Owner Name:.... ROlj4./ ..... 4vis Phone No IIr! 5d� .....
r...................................................
Facility Contact: ...............1.]Iwl4'f{ _... 8aAI&............... Title: ............. ........
....
i�11��pp
Mailing Address: .......... .T..Q.v-......!.. .........Xv Al...................................................
Onsite Representative: Rt�, A Gi ....... �G✓�-.
Certified Operator: ..............I,!.,,,,,... •. l��il ....
Location of Farm:
PhoneNo: ...................................................
nxlC�........NC.I................ .....a?... `f
integrator:....
Operator Certification Number : ............................. 1............
.............. ___......... ______.............................................................................................................................
_____________________________.........................
I ,
Latitude �� �� �•�
Longitude
T == Design Current
:; Design Current
:Poult
Design Current
Srdine -_;` Capacity Po ulation,
:.:.:, . :•., Cattle .,_.
<_ ry.. _Ca acity_..Population _ .
... �.,,.
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
-
Feeder to Finish 3��D
❑ Non -Layer
' ❑Non -Dairy
Farrow to Wean
° : --
❑ Farrow to Feeder
❑ Other
_- ❑ Farrow to Finish
Total Design Capacity
.3 Bo
❑ Gilts
❑ Boars
TF _ _ ;:w'
_ ` Toial:SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes qNo
Discharge originated at: ❑ Lagoon ❑ Spray Field [I Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes [�No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes Ngo�
c. If- discharge is observed. what is the estimated flow in gal/min? `�
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: It
Freeboard (inches): ............... ............. ........... ........ ................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
3/23/99 seepage, etc.)
Continued on ack

Facility Number: (jq- (p Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
(If any of q
closure plan'? � [:]Yes[�No
uestions 4-6 was answered yes, and the situation poses an �K\\
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 maintenance/improvement?
❑ Yes
",- No
N
9. Do any stuctures lack adequate, gauged markers with required maximum_ and minimum liquid level
elevation markings?
❑ Yes
91 No
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
® No
12. Crop type
13. Do the receiving crops differ with those designs d in the Certified Animal Waste Management Plan (CAWMP)?
[Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ No
b) Does the facility need a wettable acre determination?
❑ Yes
RA No
c) This facility is pended for a wettable acre determination?
❑ Yes
VNo
15. Does the receiving crop need improvement?
❑ Yes
V No
16. Is there a lack of adequate waste application equipment? ❑ Yes *No
Reuuired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
O(No
1$_
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?.
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
jrNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
(KYes
❑ No
20.
Is facility not in compliance with any applicable- setback criteria in effect at the time of design?
❑ Yes
[A No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
5f No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [P'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes V. No
24. Does facility require a follow-up visit by same agency? ❑ Yes V.
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes W No
0: 10 violatigns:or de cier�cies were ppt0. iipmg ois:visit; • Y:oik Will •r' eeelVe Rio further
corresp&ide' e: ab' ' this :visit
Comments -{refer to ^ uestton # E lain any YE_S answers ralf&6failyOmmendatxons of any other comments
Z.
Use;drawings of faWity to,better explain:srtuations-(iii"dditional'pages as:necessa'ry
Ala�cS �k�G t„rr�t' urt tS lisrt 4 Carp, on. Ole -.
�p jQ CCo ABlCU1
M P�.-I gPecr" %� CJ�F-P� c� �a �ra�m injc'
Reviewer/Inspector Name a
Reviewer/]nspector Signature:
': c 21-IT . 4
Date: 4-,U -
3/23/99

1• '
Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes (INo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes /[ No
roads, building structure, and/or public property)
29- Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
ktiona ommenEs"an or awiags
r
3/23/99

13 Division of Soil and Water Conservation [3 other Agency
'Division of Water Quality
14FRoutine O Comellaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection oZ= O0 24 hr. (hh:mm)
© Registered 10Certified Applied for Permit 13 Permitted JE1 Not O erationa] I Date bast Operated:
p / ff /�
Farm Name: ................ O!;tRlo[ ...ti!-A: i115..........: �-f r�► k.................... County:........................en....................................
Q ...... "--....... p G
Owner Name:. ...... .........RarLR:lG.i............. ............ 4,+/t.S Phone No: .,tj 54 .".... 3......
II.... ..-.......... ... 95'.
Facility Contact: ..Knnaiet p a v t 5 Title: Phone No: ................................
...... I...........Q
Mailing Address: �.. Illr!l1 ............ D .......�`�(d�L tY�i �r T.-�.... .6�.... a� ........`:v.......----"........................ a:... 3...... C..........................
Onsite Representative: ..................... . Integrator:..--... 1]S C C ?�!,{'7c,,•,
........ �........
............
.....
pp .^
Certified Operator: ................ F .!IE,L: ....-------•--- ............... Es .......................... Operator Certification Number,----.....�
1.n.._.......
Location of Farm:
......... ........................._..........................................._............................................................................................................ ...
Latitude • 0` « Longitude • 06 "
aY=
a• .
Design. ,. Current Design Current
Capacity `;Design" Current
'S Jine :.. Ca . p y Population .-Poultry ry � Capacity Population.- Cattle � :'." ' . =Capacity Popeiiat<on;;
❑ Wean to Feeder
Feeder to Finish
34 0:;'
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other; F
R Total Design Capacity y
a
Neunber of Lagoons l Holtimg Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
10 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [IRNo
2. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes IIOhNo
c. If discharge is observed, what is the estimated flow in gal/min? P
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 1'No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number: or, — Ifft, 1
8. Are there lagoons or storage ponds on site which need to be properly closed! Cl Yes MN�o
71
Structures (Lapoon.s.11oldine Ponds. Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
0 yes
9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ....................................
..... ..............................
10, Is seepage observed from any of the structures?
0 Yes
0 No
It. Is erosion, or any other threats to the integrity of any of the structures observed'?
[I Yes
ONo
12. Do any of the structures need maintenance/improvement?
X Yes
0 No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'
❑ Yes
[XNo
Waste Application
14. Is there physical evidence of over application?
El Yes
K No
(if in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ............. _5 0 J �.__ _1 ............ .................................................................................................................
. ...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWNIPP
El Yes
VNo
17. Does the facility have a lack of adequate acreage for land application?
0 Yes
No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
Yes
El No
20. Does facility require a follow-up visit by same agency?
❑-Yes
XNo
21. Did ReviewerA nspector fail to discuss review/inspection with on -site representative?
❑ Y C s
No
22. Does record ke'eping need improvement?
El Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available"
El Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
0 No
0 No,viola'tio'n's-or'd6fi'cie'nc'ie's were noted -during tbis'visit.-.Yo'u.w'ilI receive no ftirther
i-ofr&Pbfiden& allout this visit'.-
' re e r,to question #) =E tplainj:irij4E&afiiwer_s an- i d/orany.recommAn�&tions"'or any otherc
s rawi s., a61ty4o: et"te­
w b r explain: situations.. (use addtitonal'o &as.necessary).-
ax"" OL P,61ao Qr� dh O7V 4j ML�
4AC& �.�., s
V,
.31-3619 -1. AIJ
P11 t245/97
oG- 700
fe -
--q
Reviewer/Inspector Name 7r f!",
rtXAJ, -7 , , �7_
Reviewer/Inspector Signature:— dUL Date: 2-9-9e

,y. .� RK A .^✓� .fit. ` 1 ., `. _ � T -§G-. - f -
i �,3 � � a - .,. ....k �.fy, " � .^,�..� d = x ,'""°'e4_�n �`€ 4 � � tip �•. '�'- `�, e
5` �� ❑ DSWC Animal Feedlot Op erat><onReview�
- -'''
yo `' s,, ,tetra& mks awYa n C%gr `�" � t� .
a .� �, • � � �
DWQ An>fmal Feedlot Operation€Slten5pectlons �x
®,emt xs, r -- x�6,.,,Itbrr�. ;ems ' �- �; &ate ,��� "» i a.�'� .0 ` `�%a�smz"za'aye '�nr x✓�
77-E.€"e w-...'� "' :' t�x�az �,., :�. b:::., x. `.- m''a w'`4a", .° »aoav- +sa ash. °s'ayr. ., ,Y-, svxsx€£
rQ Routine 0 Com taint 0 Follow-u of DWQ inspection 0 Follow-uO of DSWC review 0 Other
Facility Number
Date of Inspection
4 /
Time of Inspection / : 30 24 hr. (hh:mm)
Total Time (in fraction of hours
FarmStatus, ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review I�
' iff Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:
Land Owner Name: _.�v�✓.s� 11�-�.. .. ..... _ ... �.. _..
County: d?llr...�✓p .. .w.......__.
Phone No:.. ?Zl _
Facility Contact: _�^�!�p �Jis .. Title: / _ Phone No:
Mailing Address: ��4i ®��U,L ....�F✓2`! A` C
— - — — — - — -
Onsite Representative:. ..� _ ,. _ Integrator:��c`1`J �..�EQ���
Certified Operator:.."�''¢?'�*!���.. �!-5 Operator Certification Number:_. ....._. � .
Location of Farm: ��., �a _ %� _ � .�� �'�d S ',52w,
C
Latitude Longitude ' 0°
Type of Operation and Design Capacity
�.
�4 CllrreAt De$r sCurrent " M �Dest � Cutt t -
�zx*...""'� .;'� �'.--���m%a._„`sw.;
SWIne sb > -.fW wP ) �.attle "fP ruu
�7 Ca ac Pii ulahon A - e .. tTY e ...= Ca ac�ty Po ulatian Ca ifd Z o uiatioti
❑ Wean to Feeder La " ,', ❑ Da'
Feeder to Finish Ada ❑ Non -La er ❑ Non
Farrow to Wean
Farrow to Feeder ; Natal Design, , aerty�
p ��
Farrow to Finish° xj
w.wtiw�WTot .F SSLWff�
Other
fi
Nnm6er of Lagoons / N10Mi1Q Ponds / Subsurface Drains Present
Lagoon Area ❑Spray Field Area
C end
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
e, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/9 7 maintenance/improvement?
❑ Yes [$No
❑ Yes [XNo
❑ Yes MNo
❑ Yes M[No
❑ Yes
I%No
❑ Yes
qNo
❑ Yes
ONO
❑ Yes
A No
Continued
on back

Facility Number:... �Z..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;&No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
XNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
04 No
—Structures (Lagoons and/or 11oldigg Ponds}
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
VNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
7�
10. Is seepage Observed from any of the structures?
❑ Yes
O� No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
,Yes
❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Jallo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
kNa
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .. r�f2l�.e^_'1� _............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
JSrYes
❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes IQ No
18. Does the receiving crop need improvement? ❑ Yes )No
19. Is there a lack of available waste application equipment? Yes ❑ No
20. Does facility require a follow-up visit by same agency? ❑ Yes J4 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes tq No
For!Ctrtified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes kfNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes .9 No
24. Does record keeping need improvement? ❑ Yes allo
Comments ;(refer to'question #) Explain anyEYES' answers"and/or any recommendatrans'or`any. oti�er:conimeats: ;
Use dawings,of facility tobetter explain situations. (use additional pages ;as necessary)'
y
G,�.s-�.r` 5�7 �.G,.-�2.art-Gr ��G,.G,fo%�,q Al .✓�.EO-� �
1z
rd
Reviewer/Inspector Name _ r"r _ MM� Vl�
Reviewer/inspector Signature: �.� � � Date: d ! / — y %
cc: Division of Water Quality, Water Qualit), Section, Facility Assessment Unit 4/30/97

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
FAYETTEVILLE REGIONAL OFFICE
DIVISION OF WATER QUALITY
July 28,1999
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ronald Davis
6488 Highway 21OW
Garland, NC 28411
SUBJECT: NOTICE OF DEFICIENCY
Ronald Davis Farm
Facility No. 09 -186
Bladen County
Dear Mr. Davis:
On June 22, 1999, staff from the Fayetteville Regional Office of the Division of Water
Qualk conducted a routine inspection on your swine facility located in Bladen County. It
appeared that one of the waste application fields did not contain the correct receiving crop
as specified in the Certified Animal Waste Management Plan (CAWMP). Tobacco was
being grown in this field, however the crops specified for this field are wheat and soybeans.
It was noted that freeboard records were not being maintained weekly as required by the
General Permit issued to this facility on December 28,1998. General Permit condition 111.2
states that "Waste lagoon and storage pond levels shall be recorded weekly on forms
supplied or approved by the DWQ.'.
It was also noted that the facak failed to have a soil analysis for 1998 and a current
waste analysis. General Permit condition 111.3 states that "A representative Standard Soil
Fertility Analysis, including pH, copper, and zinc shall be conducted annually on each
application field receiving animal waste. The results of these tests shall be maintained on
file by the Permittee for a minimum of three years and shall be made available to the DWQ
upon request.". General Permit condition IIIA states that "An analysis of the animal waste
shall be conducted as close to the time of application as practical and at least 60 days
(before or after) of the date of application.
The Division of Water Quality requests that the following items be performed:
1. Contact a technical specialist in order to revise the CAWMP to reflect the crops to be
grown along with the specified Plant Available Nitrogen (PAN) rates for each crop.
2. Immediately begin recording weekly freeboard levels in order to be in compliance with
the General Permit.
228 GREEN STREET, SUITE 714, FAYETTEVILLE, NORTH CAROLINA 28301.5043
PHONE [phone] FAX 9l0-486-0707
AN EQUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST -CONSUMER PAPER
:3'9s

Page 2
Ronald Davis Farm
July 28, 1999
3. Take a soil sample annually and a waste sample as close to the date of application as practical but at least
60 days before or 60 days after application as required by the General Permit and the CAWMP.
Please notify this office in writing on or before August 20, 1999 at the letterhead above as to the actions
taken or proposed to be taken to resolve these deficiencies. Nothing in this letter should be taken as absolving
this facility of the responsibility and liability of any violations that have or may result from these deficiencies.
If you have any questions concerning this matter, please do not hesitate to contact myself at [phone].
Sincerely,
^Brownn Aerka-t,
Environmental Engineer
cc: Sonya Avant - Compliance Group
Sam Warren - Bladen Co. NRCS
Audrey Oxendine - DSWC Fayetteville Office
Central Files - Raleigh
Jimmy Vinson - Brown's of Carolina, Inc.

CAFO
Fayetteville Regional Office
OMPLAINT
.ODOR COMPLAINTS(SEFNOTEBELOWFORPanTRYREu{TEDCOMnAINTS)
ALL ODOR COMPLAINTS SHOULD BE FORWARDED TO THE DMSION OF AIR QUALITY
.OTHER
DATEMME REC'D Y�1 =-7,
DWQ CONTACT(PERSON TAKING THECALL) r l
PERSON CONTACTING THE F.RO. L r cti we-oJ—de,
TELEPHONE NO,
ADDRESS
FARM NAME:a ►tip �nl i5 __ [ �� .
FARM OWNER:
COUNTY L x=6k f-,, _FACILITY NO. 6
te
DIRECTIONS TO FARM_ z 10 �-
NARRATIVE#OR ODOR COMPLAINTS PLEASE RECORD WIND DIRECTION, 48 HOUR PRECIPITATION, TEMP„ AND 4F WASTE APPLICATION WAS IN PROGRESS.
ALL CAFO COMPLAINTS SHOULD BE LOGGED ON FILEMAKERPRO (POULTRY COMPLAINTS SHOULD BE ENTERED UNDER THE
APPROPRIATE COUNTY NUMBER STARTING WITH THE COUNTY NUMBER AND THEN WITH A#>THAN 1000. EXAMPLE 06-1D01)
FILE IN THE APPROPRIATE CAFO FILE, POULTRY COMPLAINTS SHOULD BE FILED IN THE POULTRY FILE IN THE FRONT OF EACH
COUNTY,

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Ronald Davis
Ronald Davis Farm
6488 Hwy 21OW
Garland NC 28411
Dear Mr. Davis:
TWA
[D E H N FR
April 3, 1997 F1 ECM VE UF--'%%
APR 0 7 1997
FAYF_17E-ViE1. .
REG. ELF=FiC6
SUBJECT: Notice of Violation
Designation of Operator in Charge
_Ronald Davis Farm
Facility Number 09--186
Bladen County
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator:
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
W. 9
for Steve W. Tedder, Chief
Water Quality Section
bb/awdesletl
cc: Fayetteville Regional Office
Facility File
Enclosure
P.O. Box 29535, Aw FAX [phone]
Raleigh, North Carolina 27626-0535 �fAn Equal Opportunity/Affirmative Action Employer
Telephone [phone]% recycles/ 10% post -consumer paper

hype of visit: (tMompliance Inspection U Operation Review U structure Evaluation U Technical Assistance
Reason for Visit: 0 rcoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: A-e- Arrrival Time: L Jo Departure Time: 19 ' we] County:- 3 iajeLl
Farm Name: z-':- 'C 5- Owner Email:
Owner Name: FA Q k"V--t�Itg : /�� � ^415 kZ& Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
u�`GtJ Title:
Onsite Representative: r(
Certified Operator: —(3aw Ci 3 -ei m5'KL
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: FI 0
Integrator: 1�
Certification Number: [ V 70
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Fettle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
a�
-
Dairy Heifer
Farrow to Wean
-Design u en
Dry Cow
Farrow to Feeder
D , P.oul Ca aci Pro .
Layers
Non -Layers
Pullets
Turkeys
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
4 '
Other
Turkey Poults
Other
Other
Discharites and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [g-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No �A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [-]Yes [:]No [�" i�A ❑ 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 ❑ TA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [J-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 .214120I5 Continued

Facility Number: - Date of Inspection: .•c-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes E]_W ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0,W— ❑ 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 [b-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
LLf ""'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
DKo
❑ 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
S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q-Ko-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E9 ❑ 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 Types): p _ ,=,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 1S"°o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Q-N-o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U.K°
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
[ate
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q.Pd'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Tom
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2'110
❑ 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
1Vo
❑ 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
fo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Ins ection: 52
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ej-Ms
❑ 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
[Z]''I Fo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E7 no
❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M/ 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
[PN­o
❑ 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
U�No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ -K
❑ NA ❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3"go
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I a lro
❑ NA ❑ NE
CC.fj 6V4'. ,n-1 ?- Ll- lb
c'-elf 6vo- 3 off- 6 9s
G j/_�I , (7P&L( P3,( W7,
Reviewer/Inspector Name: Bill C)UVJ4 0 Phone:gr0433`333
Reviewer/lnspector Signature: Date: 3�j u
Page 3 of 3 21412015

Type of Visit: O-Co—mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Lstcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
40
Date of Visit: Arrival Time: Departure Time: 3 f, c: r I County: + Region: rqzo
Farm Name: �j �h'`e ��� i! �Cc t Lf-� Owner Email:
Owner Name: _ gtt4%I- Phone:
Mailing Address:
Physical Address:
Facility Contact: Lcc�,.}�cS (�� `Gt't Title: Phone:
Onsite Representative: �S
/� Integrator: J&(
Certified Operator: C-C-0/4 SS ct, Certification Number: 'tY f 7o r
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine CapPop.
acity
Wean to Finish
Design Currentq Design Current
Wet Poultry Capacity : Pop Cattle Capacity Pop.
La er Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish 3UiD
.Current,
..rPop.
R..Dai
Heifer
Farrow to Wean
Farrow to Feeder
Design
D F Ploul# , Ca achy
::::,:
Dry Cow
Non -Dairy
Beef Stocker
I Beef Feeder
jBeetfiroo, Cow
Farrow to Finish
Layers
I
Gilts
Non -Layers
NPullets
Boars
Qther
Turkeys
Poults
_
=
Other
Discharees and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[]P<6 ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[]No
Ef—RA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[]No
[ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DW R)
[:]Yes
[:]No
nNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
To
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

FacW Number: - Date of Ins ection: If
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-Ncr❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[3-N7C_❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q'1 o—
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E 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
ED <
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ENo ❑ 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): allu (;
13. Soil Type(s): p " O
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�]<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EErRlo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E "'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19_ Did the Facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
[] NA
❑ NE
the appropriate box,
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspection
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[] NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: - --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ea
25. Is tht facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-Ko
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 �iNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [j No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3'fVo
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 [j"No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes DrNo
permit'? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑'No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [§ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑,0&o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 1__I No
Comments (refer to question ft -Explain any YES answers and/or -any additional<recommendations or: any othek
Use drawings of facility to better explain
situations (use additional pages._as necessary).
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
3:z
q,77c
Reviewer/]nspector Name: ' 11 ` G Phone: '(O
Reviewer/Inspector Signature: NDate: '/
Pa,-, e 3 of 3 21412015

Rl'eason
ype of visit: if�pCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
for Visit: f�Routine 0 Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: � County: d 4
Farm Name: _ �C.Pry-k,� �.,G-�i•1� t �j'�` Owner Email:
Owner Name: "^'"" 4V_vo� dCy r G�L� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: C 1 � OA'--W Title: Phone:
Onsite Representative: t L Integrator: 6
Certified Operator: ��✓/' ,G 43 r`' SS Certification Number: 9 i / 7 a k
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design. Current
nt
Design CMEN
Ca aci Po
Rty_ P•
Wet Pault . Ca aci Po
ry P ty P
Cattle C•a aci
P h'
to Finish
rFeeidej
La er
Dai Cow
to Feeder
Non -La er
Dai Calf
to Finish
?,*.off
�{
I
i
DaiHeifer
to Wean
Design
.Current
D Cow
Farrow to Feeder
Non-Daiiry
D , Poult , Ca aci
1'0
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other `, . IN
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts ,--,
1. Is any discharge observed from any part of the operation? [—]Yes 0,<o E�Kr ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No Q'lGA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2_ Is there evidence of a past discharge from any part of the operation? ❑ Yes E] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [�o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120I S Continued

Facili Number: I IDate of Inspection: � .►L
Waste Collection & Treatment ���
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3' NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 56
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RJ Wo 0 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 <o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M_�6 ❑ NA ONE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [.d 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 [2�Wi9 ❑ NA ❑ NE
maintenance or improvement?
Waste Application //��
10. Are there any required buffers, setbacks, or compliance alternatives that need [::]Yes ❑'ado ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ao ❑ 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 Windrow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
C
12. Crop Type(s): W
13. Soil Type(s): Avoo b -0
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes Eqr'N'lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [�Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []eNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [�<o ❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes ["No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[?(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[To
❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
[:]Yes
[X o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
o
[DNA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -' -VEI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [e <o ❑ NA ❑ NE
4. . - "•
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes <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 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 D�<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0'Kb— ❑ 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.
❑ Yes To ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Ep o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Ea o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ZNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V 3-- .
Date: o1's. 1'
21412011

Type of Visit: (3,'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Grkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County: Region:
Farm Name: A I& GG
Owner Name:
A'd
Mailing Address:
Physical Address:
Facility Contact:
f
Onsite Representative: I(
' T
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: Q� n
Certification Number: '0 l V
Certification Number:
Longitude:
Design Current
Swine Capacity Pep.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
C0
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P,oultr.
Design
Ca act
Current
$o .
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other er
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?
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No EAeKA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Ej,>AA
❑ 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
[3-NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Io
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Rio
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

IFacility Nu ber: - Date of Inspection -
WaseCollection &Treatment ❑ ❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es o NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [3 V�A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G /f
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 [:fNo ❑ 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 [e'?lo ❑ 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 []Ofo ❑ 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 I0 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): C ms e, S G O
13. Soil Type(s): �j L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or -land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
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 ONE
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 D Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FacHity Nurdber: - Date of inspection:
24. DiB the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3111o' ❑ 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 l ,<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Cg,'Qo ❑ 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 [R<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Flo<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes C-,Ko ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �lo ❑ 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 R No ❑ NA ❑ NE
Comments (refer to;.question #) .Explain,any YES answers and/or any additional recommendations or. any, other comments
Use drawings ;of facility to better explain situations {use additional pages as necessary}. 3
s S
ta-l� b�lo
Mi)k4-e4�va*-a A_c,4 CkfraA[-C,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C
Phone: 't) S' Z3,M
Date:aiU_11yjk
21412011

Type of Visit: Q'Comphance Inspection p Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 04outine 0 Complaint Q Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: (4�� Region:
Farm Name: Gen," le-e
Owner Email:
Owner Name: „L6r(9v- ��� Phone:
Mailing Address:
Physical Address:
Facility Contact: (54t S Title: Phone:
Onsite Representative: it - Integrator: ► `i J
Certified Operator: �x�� T l� 1 L<- S l �Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Design Current
Design Current
Capacity Pet Poultry Capi:ic ty Pop.
Cattie Capacity Pop.
..
Tw
Wean to Finish FLa er
airy Cow
Wean to Feeder
Nan -La er
airy Calf
Dai Heifer
Feeder to Finish y=
Farrow to Wean Design Current
D Cow
Farrow to Feeder Dr. Po."ult Ca "a P,o ,
Non -Dairy
Farrow to Finish La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[:]Yes B<O ❑ NA ❑ NE
[:]Yes
❑ No
RJ_NA
❑ NE
[:]Yes
[—]No
L__ XA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes [:]No NA ❑ NE
P
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No ❑ NA ❑ NE,
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes eNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

•
I;acili Number: - Date of Inspection: .A
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
_
[a Imo❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [T'NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes[]
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
Q-NIT ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q"lgo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ 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
FT56 [DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C3-N-o— ❑ NA
❑ NE
maintenance or improvement?
I I. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): (f6
W
13. Soil Type(s): Iva-0
14. Do the receiving crops differ from those designated in the CAWMP?
[-]Yes
2<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EEJNo
❑ 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?
❑ Yes
EINo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[P-ICIo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
6No
❑ 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
EfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[�(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[]!rNo
[DNA
❑ NE
Page 2 of 3 21412011 Continued

a
y'aciliNumber: C4- Date of Ins ecdon:6 A0i
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ®-� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes D-ls% ❑ 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 [3-Nir ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewertinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes allo ❑ NA ❑ NE
❑ Yes D- o ❑ NA ❑ NE
❑ Yes []'N-o ❑ NA ❑ NE
[:]Yes F- No ❑ NA ❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
E'No
❑ NA
❑ NE
lR) . aP Y y �t any, Omer=comments.'`
ommen re er o u_ on an ,answers'an . or an a on recommen _
U eXdr ` x'o faCili � 0t� o bet#er a la ri itd ns {useFaad�tianal pages as necess r wutgs, ty zp p g m7').,:� -.
AA
743
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 133.3.33-
Date:
'6 4?' L2
2✓417014

■
IN
r ype of visit: w--ruompnance inspection V Vperanon Keview U btructure Lvaluation V 1'ecbnical Assistance I
Reason for Visit: G-1 outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: —6 /3 Arrival Time: Departure Time: �iS" County:,,��
Farm Name: ���� %{ ,. 's7�+ S�Y✓ Owner Email:
OwnerName: �r-0o� 1,� ��� Phone:
Mailing Address:
Physical Address:
Facility Contact: ex't';t5 3s'-'Yir44 Title:
Onsite Representative: �` Integrator: �.
Certified Operator: e an, 2"Certification Number:
Region: "r-g t7
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current' ,Design
Current
- - Design Current
Swine
.::..:
Capacity Pop. Wet Poultry
Capacity
Fop.
Cattle Capacity Fop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
on -Layer
DairyCalf
DairyHeifer
Dry Cow
ceder to Finish
Farrow to Wean
Farrow to Feeder
[7
*�
-.
D P,oult .
Design Current
Ca aci. P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 �10 ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [-]No
❑ Yes ❑ No
❑ Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili Number: - 8' Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / y-
Observed Freeboard (in):Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ` ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): irVe , % Ad'd / / Gl%,¢
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes to No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
1.41
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA [:3 NE
Page 2 of 3 21417011 Continued

Facili Number: jDate of Inspection: —/G--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EQ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 0,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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [SNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ 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
a No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
Phone:
Date:
21412011