820725_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

�11U15 I`� a r•1 I � !�
ivis`ion of Water Resources
Facility Number t --.tea - a,S ©Division of Soil and VF'ater Conservation
© Other Agency
Type of visit:�om liance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: rd Routine 0 Complaint 0 Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: let Arrival Time: Departure Time: Dr County: Region��
Farm Name: ilM ]a[p -L-7 Owner Email:
Owner Name: D +`Q Phone:
Mailing Address:
Physical Address:
Facility Contact: �L-` i S o✓WtF.f t Title: Phone:
Onsite Representative: Integrator:
Certified Operator: 't Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren
Design
Current
Design Curren
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish 9 00
Dairy Heifer
Farrow to Wean
Desigu
Current
Dry Cow
Farrow to Feeder
I) . Poult
Cia i
Pa P.
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes B -Ko ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No E3 -NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [B -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 [D -N -A— ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [a'�'o ❑ 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 3 214/2015 Continued

Facility Number: - Date of Inspection: 17
❑ Yes
No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[-�No
❑ NA
%4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑1►ie�D NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
_l1 A
E3-NA—
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Yes
Identifier:
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Spillway?:
❑ NA
❑ NE
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesdNo
Observed Freeboard (in): L{ .5'
El NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LrJ "'°
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2-M
❑ NA
❑ NE
waste management or closure plan?
1f 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
✓❑'NNo
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
la<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
n NNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Q Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2:n, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manore/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): .A" s G (,'
13. Soil Type(s): /Ut, I')I ti I,ka&'(I ct
14. Do the receiving crops differ from those designated in the CAWMP? l
❑ 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
rZj-l�o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesdNo
El NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EfNo
❑ NA
❑ NE
the appropriate box_
❑WUP ❑Checklists [—]Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"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 D_Ko'
X25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes -UT<o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C9 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility) If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q-Iqo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative? ❑ Yes [f No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q o ❑ 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).
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ONo ❑ NA ❑ NE
❑ Yes [, No ❑ NA ❑ NE
[:]Yes (-No ❑ NA ❑ NE
❑ Yes E No [] NA ❑ NE
C, J; � t>4 l s,�
5(wQryeeNI___ F�x(9
Re viewer/]nspector Name: 1.� l
r
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1� "� J J
Date:
21412015

01
Type of Visit: Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: @'Routine O Complaintt 0 Follow-up O Referral Q Emergency 0 Other D Denied Access
Date of Visit: Arrival Time, 10 A—I Departure Time: County: sift Region
FFO
Farm Name: "'� Owner Email:
Owner Name: C1 b;
,q� Q�%''�"s Phone:
Mailing Address:
Physical Address:
Facility Contact: a S]vw'! Title:
�i
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
NftwDesign Curr nt, - Design Current _ = Dcsign Current
a,= "
Swine Capacity. Pap ; � �'�Vet Poultry Gaii i LCattle Capacity Pop.
Wean to Finish Layer Dairy Core
Wean to Feeder Non -La er I Dairy Calf
Feeder to Finish ( Dairy Heifer
Farrow to Wean J Westgn Cum rent Dr Cow
Farrow to Feeder 3D P-oult acct *,?Fa Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Qeef Feeder
Boars = Pullets Beef Brood Cow
TM Turks s
Qther "*#,�; TurkeyPoints
Other Other s
Diseharees and Stream Impacts
1. Is any discharge observed from any pan of the operation'?
❑ Yes
OXr❑ NA
❑ NF
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[:f'NA
❑ NE
b. Did the discharge reach eaters of the State? (If yes. notify DWR)
❑ Yes
❑ No
[ff 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
[Z�NA
❑ NE
2. 1s there evidence of past discharge from any part of the operation?
❑ Yes
El 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 I of 3
21412015 Continued4

Facitity Number: Date of Ins ection:
Waste Coiiection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P'I�fo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P�rNA ❑ 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 EffNo ❑ 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
dNo
❑ NA
❑ NE
waste management or closure plan?
0 Yes
Ea*No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify D"
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
["No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RTNo
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
Waste Analication
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
14. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z -No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
the appropriate box.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence oo/f�� Wind Drift ❑ Application Outside of Approved Area
i-SIrJ
12. Crop Type(s): _ e `
13. Soil Type(s): fV`0 U1 aA&F� K a✓`y:1Yl
_
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
Ea*No
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
✓[ "No
❑ NA
0 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
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z"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 ErNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ RainfaIl ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [f No
❑ NA ❑ NE
❑ Weather Code
ED Sludge Survey
0 N ❑NE
[] NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: '
24: Did th! facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®-t o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!'1Vo ❑ 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 EE -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [3<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Ogee of emergency situations as required by the ❑ Yes [Et"lfo ❑ 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
ETVo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q.No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[:�_No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
&GUAI a-.,— <�--
rt
Cd I
Reviewer/Inspector Name: T I`� L_1 124 o Phone: 433 `3W
c
Reviewer/Inspector Signature: l Date: %1
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: I.11 �y / f/ I Arrival Time: Departure Time: County: " [legion: ��
Farm Name: eiL' - haJ*f 47 Owner Email:
Owner Name: C-0 I&L-in Phone:
Mailing Address:
Physical Address:
Facility Contact: C- w-, , 5 rj,,-Cc/ 14,& Title: Phone:
Onsite Representative: l I
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: f PeC56�e
pr !,
Certification Number: l0 3 't 7
Certification Number:
Longitude:
Pullets
Turkeys
Turkey Points
Other
Discharges and Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No [:]NA E] NE
❑ Yes [:]No [�A ❑ NE
[3 Yes E] No [!NA ❑ NE
d_ Does the discharge bypass the waste management system? (if yes, notify DWR) 0 Yes [—]No ❑ NA [—]NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�Io E] NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes ff No [:]NA E] NE
of the State other than from a discharge?
Page I of 3 .114/2014 Continued
Design Current
-III -Design
Carrent
Resign Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop..
Cattle Gapatity Pop.
Wean to Finish
La er
Dairy Cow
- Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
_ . r
Design
'Current
Cow
Farrow to Feeder
;Il . Point ,"�
Ca acit�
°'1?0P
Non -Dairy
Farrow to FinishLa
ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Beef Brood Cow
(J►ther
r.
Other
Pullets
Turkeys
Turkey Points
Other
Discharges and Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No [:]NA E] NE
❑ Yes [:]No [�A ❑ NE
[3 Yes E] No [!NA ❑ NE
d_ Does the discharge bypass the waste management system? (if yes, notify DWR) 0 Yes [—]No ❑ NA [—]NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�Io E] NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes ff No [:]NA E] NE
of the State other than from a discharge?
Page I of 3 .114/2014 Continued

Facility N ber: -72- jDate of Inspection:
Va'*�o
❑ NA
❑ NE
❑ Yes
w
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[3' -No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
�-#o'
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
EQ-*A
[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and I " Rainfall Inspections ❑ Sludge Survey
Spillway?:
❑ Yes
No
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
No
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
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
�lo
0 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 [3' -'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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;� No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding E] 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 �i ❑ EvidenJc_e of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1] twku-I& 576
13. Soil Type(s):
ID
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
Va'*�o
❑ NA
❑ NE
❑ Yes
C3 No
❑ NA
❑ NE
❑ Yes
[3' -No
❑ NA
❑ NE
❑ Yes
EKNo
❑ NA
❑ NE
❑ Yes
Ei/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�`Yo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists C3Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ 0No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Facili • Nuntlber: -S:'2. - Date of inspection:
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 [3-55 ❑ 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? E] Yes No C] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3"No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ 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
�io
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
e
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
F.PrNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
ZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes
2] 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).
Reviewcr/Inspector Name
Reviewerllnspector Signature:
Page 3 of 3
Phone: lm?' 33-5K
Date: A!, I �
214/2014

' 111tiS Ijv- �`
Type of Visit: Q•eomplianee Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: el routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: d Arrival Time: Departure Time: �r County:
Farm Name: «-�+d!l�w�c'T% Owner Email:
Owner Name: Ch-AA6-t.Phone:
Mailing Address:
Physical Address:
Facility Contact: CG4, T[. S
Onsite Representative: ( (
Certified Operator: Ct
Title:
Region:
Phone:
� f
Integrator: 8T�7`q.Q
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Curre tj
' Design
Current
^ Design Current
S wine Capacity Pop.
Wet Poultry Capacity
Pap.
Cattle ., Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish 15
_ '--'
Dairy Heifer
Farrow to Wean
".: Design
Current
Da Cow
Farrow to FeederD
• Po'iil Ca act
. P,oP
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other-.,
T ey Poults
`w
Other
10ther"
'
Discharges and Stream Impacts
1, Is any discharge observed from any part of the operation? Yes io [] NA NE
Discharge originated at: 0 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 E3<A E] 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) El Yes El No EfNA ❑ NE
2, is there evidence of a past discharge from any part of the operation? Yes B510 0 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 J of 3 2/4/2014 Continued

1
Facili Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No _E5-'9A__
U9A_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
T
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
L!J o
[] NA
❑ NE
acres determination?
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?
❑ NA
[:3o NE
18. Is there a lack of properly operating waste application equipment?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify D"
7. Do any of the structures need maintenance or improvement?
❑ Yes
l_ 7 "'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
To
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q -i ib
❑ NA
❑ NE
maintenance or irnprovcment?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3'lQo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes la ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Hea%y Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window``''��❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): IV -b /AL / "%*(,,
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
brio
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
L!J o
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[:3o NE
18. Is there a lack of properly operating waste application equipment?
© Yes
go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
0 N ❑NE
❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

acility Number: - 7 S Date of Inspection:
--
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes []►ldq'7 ❑ 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 first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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, aver -application)
3 I . 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 noncompliance of the permit or CA W MP?
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?
C
CL
wtV-Acwo 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
❑ Yes
C3-NQo
❑ NA
❑ NE
❑ Yes
EJNlu
❑ NA
❑ NE
❑ Yes
L -lq-o
❑ NA
❑ NE
❑ Yes [� [:]NA ❑ NE
❑ Yes [,-],W ❑ NA [] NE
❑ Yes
[:],l�o
❑ NA
❑ NE
❑ Yes
; to
❑ NA
0 NE
❑ Yes
No
❑ NA
ONE
[—]Yes
[T No
❑ NA
❑ NE
Phone: 4.S3
Date: C r'`'
2/412011

L
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation ( Technical Assistance
Reason for Visit: &,routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J Arrival Time: : pD Departure Time: CountyRegion:
Farm Name: L. Gs:7� G �— Owner Email:
Owner Name: r; z- p Pcrer'o -- _ Phone:
AIF
Mailing Address:
Physical Address:
Facility Contact:
Title: yrs Phone:
Onsite Representative: �j,�^ Integrator:
-- Y
Certified Operator: , S�r.� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
CurrentDestgn'
Current
Design Current
Swine VIS „Capacity
Pop.
Wet Poultry Capacity �` Pop.
�.:
Cattle�N1 " Capacity Pap.
❑ Yes
[4No
❑ NA
❑ NE
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non La er
Dairy Calf
Feeder to Finish a
fyLora
„mss,:
Da'y Heifer
Farrow to Weana�Uensign,,,,Current
.max
Dry Cow
Farrow to Feeder
D , pl'oul _}=-Capacity P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
113eef Feeder
Boars
Pullets
Beef Brood Caw
Turke s4.
O -cher ,.
TurkeyPuults*
Other
Other
Z
Discharees and Stream lmnacts
I. Is any discharge observed from any part of the operation? ❑ Yes [H 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 0 NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
LRNo
❑ NA
❑ NE
❑ Yes
[4No
❑ NA
❑ NE
Page l of 3 2/4/.2011 Continued

Facili ]Number: - Date of Inspection: =
—/
E] NA
C] NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo
❑ 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
ER 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
[RNo
❑ 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
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZLNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L'-Lcj-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
l2. Crop Type(s): .r,rc dG/Sr
13. Soil Type(s): ALO alb fi
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes 2[No❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes JZ 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
r No
E] NA
C] NE
❑ Yes
ES No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes EINo ❑ 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 ER No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA C—] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
DNA C] NE
Page 2 of 3 2/412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ENo
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 [K No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EINo
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.
0 Application Field. ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes I+R No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes rVI No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes OLNo
[—]Yes K No
❑ Yes CK No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: jp y33 `33LZ)
Date:
2/4/2011

I 142M
TME -1 141g1l'a- I?-
a
jType of Visit: (15 Compliance Inspection U Operation Review U Structure Evaluation () Technical Assistance I
(Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: a?_'Ut7 Departure Time: al CountyZ
jam,52 r% Region: rIZV
Farm Name: R �, 1 g IUC . --1 Owner Email:
Owner Name: C 0 h A /LTP HG _� Rin,5 Phone:
Mailing Address:
Physical Address:
Facility Contact: C_u%4 25 aykyLy4Sfrl< _ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: C; UMa 5 !� p{Z WxGK Certification Number: N S 3 "A1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes
❑ No
Design
Current
[:]Yes
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Ponitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
1
Non -Layer
N
Dairy Calf
Feeder to Finish
5$
&786
Dairy Heifer
IAM
Farrow to Wean
Design
Current;"
Dry Cow
Farrow to FeederD,
P,oult a ``
`;; a aci_ty
P,o _
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Q#her
I U1 Key Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes
❑ No
Q NA
❑ NE
[:]Yes
❑No
[YNA
❑ 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 [Z NA ❑ NE
Z. is there evidence of a past discharge from any part of the operation? ❑ Yes [3�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes g No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Facil!q Number: - Date of inspection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9 No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? 0 Yes Ea/No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): qq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P�fNo ❑ 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
[gNo
❑ 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
[5 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E�rlNo
❑ 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
[3 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 Drill ❑ Application Outside of Approved Area
12. Crop Type(s): ZF RmvflP [ "61
13. Soil Type(s): a 1�-,) _ c� �j ; (� �, R \.1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z 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?
1 S. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [d]' No ❑ NA [] NE
❑ Yes [tr No ❑ NA [] NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�'No ❑ NA D NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [w 'No
❑Waste Application El 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 EZfNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
[� NA ❑ NE
Page 2 of 3 1./4/2011 Continued

Facility Number: Ff a - ia, Date of Inspection: jt -1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6�'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [!�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [q 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[afNo
❑ 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
(2 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
CyNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Gj No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[4 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andfor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: Im x+51
Date: to
2/4/2011

- � rtes e -/i-3/ " 14,
Type of Visit: f—'7 Compliance Inspection V Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: 42rgo—utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ! Arrival Time: Departure Time: i tap County: Region: '�
Farm Name: ._4:x�V S Ulf — �' �% Owner Email:
Owner Name:[gra✓, �Phone:
Mailing Address:
Physical Address:
Facility Contact: a 4-.; �QlY✓[[%[� Title:
Onsite Representative: SAL". _
CertiEed Operator: rc/' r5 Ba<z..rJ_
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: &574�%_.e
Certification Number: le?3LZI
Certification Number:
Longitude:
Discharges and Stream Impacts
Design Current
Design
Current
Design Current
Swine Capacity Pop.
�'V,etrPo�- ultry Capsactty
P,op.
Cattle ,._ CapacityPop.
s
a. Was the conveyance man-made?
Wean to Finish
Layer
&KA
Dai Cow
Wean to Feeder11AFFRINon-Layer
[:]Yes
C]No
Da Calf
Feeder to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
-
Dai Heifer
Farrow to WeanDesigu
Current
Dry Cow
Farrow to Feeder
D r ` PouIt , Ca c'i
Po
Non -Dai
Farrow to Finish
La ers
NA
Beef Stocker
Gilts
Nan -La ers
o
UBeef Feeder
Boars
Pullets
I I Beef Brood Cow
Turke s
Other TM
TurkeX Poults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
E "o
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
C] No
&KA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
C]No
ED -NA'
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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 1 of 3 214/2011 Continued

Facili Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 01<0 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: f
13. Soil Type(s):
Spillway?:
14. Do the receiving crops differ from those designated in the C WMP?
❑ Yes
[v]No
❑ NA
Designed Freeboard (in):t!v
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lg-No
❑ NA
Observed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
ET"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ri--Wo
❑ NA
❑ NE
waste management or closure plan?
Required Records & Documents
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?
❑ Yest[1IGo
❑ NA
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
CgH<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q,?4 ❑ 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): 01- -ce. c,
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections [:)Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No IA ❑ NE
Page 2 of 3 214/2011 Continued
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the C WMP?
❑ Yes
[v]No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lg-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'16o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]-1qo
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections [:)Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No IA ❑ NE
Page 2 of 3 214/2011 Continued

F
acili Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �10 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E_le— ❑ 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 [Ej'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No TA ❑ 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:
E3 Yes �o ❑NA ❑NE
❑ Yes -l<o ❑ NA ❑ NE
❑ Yes E]�No ❑ NA ❑ NE
❑ Yes Q-116 ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes
aj-Ko
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
H3110
❑ NA
❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1 4 cc sem CT9
ck_'� J� e.-ts .
C�
Reviewer/Inspector Name: 1 lMy
t IV
Reviewer/Inspector Signatur .
Page 3 of 3
Phone: j /0: ,33 -333
Date:
2/4/2011

$%K4,S { -zz -zo1 0
Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tlRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /-2/ /O Arrival Time: I g , 3fl P... 1 Departure Time: 3 %/S County: S n/ Region:
Farm Name: C ' Owner Email:
Owner Name: �o�� �t ra Y KSS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
r } S 5,dvwit Title: SPS Phone No:
Onsite Representative: Integrator: C 0 "o -Vie,
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =I 0 11
Longitude: =0=6 ❑ "
Design Current
SwineWC-3,pacity PopulationWet
❑ Wean to Finish
Design Current
PoultrMe apacity Population
Layer
Design Current
Cattle Capacity Papulation
❑ Dai Cow
❑ Wean to Feeder
-Layer
El Yes
❑ Dai Calf
Feeder to Finish BS f] 05`�/
❑ NE
❑ Dai Heifer
❑ Farrow to Wean
PQ
D Cow
❑ Farrow to Feeder
a_ Was the conveyance man-made?
❑ Non -Dairy
Farrow to Finish
vers❑
❑ Beef Stocker
Gilts
n -La erslets
❑ Beef Feeder
❑ Boars
❑ NE
❑ Beef Brood Cowi
❑ Turke s
Other
❑ Other
❑Turke Paints
❑ Other
Number of Structures:ELI
Nv/a
,��.A
L7,N
Eld. NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
D A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EI<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Does discharge bypass the waste management system`? (If yes, notify DWQ)
❑ Yes
Nv/a
,��.A
L7,N
Eld. NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑,
LTivo❑
NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
9-N�o ❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

/-Z/-zo/O
Facility Number: BZ — 7Zf-_ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):(p
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes � No ❑ NA [INE
❑ Yes LJNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L'r No [:INA ❑ NE
❑ Yes Lilo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta;No
r , notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Apl2lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes BNo ❑ NA ❑ NE
❑ Yes L! No ❑ NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
EINE
❑ NE
12. Crop type(s) - ►' kr[a, E %*f sl�t� l� �j';n! CO.
13. Soil type(s) No Lr �q ti/ �n nS )44a.�- y
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
Q'_No ❑ IATA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
ff No ❑ NA ❑ NE
to ❑NA El NE
Reviewer/Inspector Name :',�� % {��� �- '� Phone: ?/0-33 .3.304
ReviewerA nspector Signature:.0 Date: 1-21-2010
12/28/04 Continued

• FacilityNumber: i-zl-ZalD
��—�ZS-" Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes OrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EYNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections [:1 Weather Code
22. Did the facility fail to install and maintain a rain gauge? C3Yes EJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L7 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3 No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,_/
L[7TNo
❑ Yes
No
❑ NA
❑ NE
LI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
❑ Yes
BIC
❑ NA
❑ NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,_/
L[7TNo
E] NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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
ONo
❑ 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
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L3<o
❑ NA
❑ NE
Additional Cotnmcnts and/g0,Prawidgs P G
12/2&04
12/2&04

. . B. i- 4S /0-0 6 - zoo 9
0 Division of Water Quality
Facility Number 7Z 0 Division of Soil and Water Conservation
0 Other Agency 11
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: 1O `� Arrival Time: /�. Departure Time: ��� County: E'— 41
3
Farm Name: j— Owner Email:
Owner Name: _Y_Li_ Phone:
Mailing Address:
Physical Address:
Region:
r
Facility Contact: �� �-�� S: r;�/:c ,� Title: �p"'Phone No:
Onsite Representative: integrator: _CDA e k/ C �^
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: =0 =6
Longitude: =0=1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Laver
❑ Wean to Feeder 10 Non -La et
eeder to Finish C�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys;
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design . Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ No
[ AA
❑ NE
❑ Yes
❑ No
CINZA
❑ NE
ErZA
❑ NE
❑ Yes
❑ No
❑ Yes
❑I�o`_
❑ NA
❑ NE
❑ Yes
❑❑
NA
❑ NE
12/28/04
Continued

i ;im—
Facility Number:P2 -72-5-1 Date of Inspection
0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FNo
N ❑ NA E] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [I NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes CrNo ❑ 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
NNoo
El NA
[:1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
��
L7 No
[:INA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
B<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require
El Yes
No
❑ NA
El NE
maintenance or improvement?
No
❑ NA
❑ NE
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CrNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) �w 174 '7 ) , 5��� lv rc; �-z_. t/O . S . J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[[TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LI N.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
B<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�
Reviewer/Inspector Dame Phone: 3J.j7f/
Reviewer/Inspector Signature: Date: e% -f - ZOO
12128/04 Continued

Facility Number:— Date of Inspection !�
Required Records & Documents ,�,•�
[:1El19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ EJ'
14'o ,EJ tv/o NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:1 Yes o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design E3 Maps ❑ Other ,�,��
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes L7 Nn ❑ 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 Ejj o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Blo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B N'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ETIoo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ YesNo
NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�'
E] 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
El Yes
e
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,.�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
,L.TN�o
j<o
1_
[:INA
❑ NE
Comments and/or Drawings:
12129104

GHTIvision of Water Quality-
Facility Number O Division of Soil and Water conservation
OOther Agency :.
Type of Visit 0-6ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure "Time: 'Qp County:
Farm Name: Cokayl t- 7 Owner Email:
Owner ,dame: CCti1Cya a t6f, fia, Phone:
Mailing Address:
Region: '=AW
Phvsical Address:
Facility Contact: C w._4,':5 vw i c— V, Title: :� . ����_ __. Phone No:
Onsite Representative: I`nttegrator: jja+-,'&y0.t S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =I = q Longitude: ❑ o ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑
Layers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the convevance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai I-leifei
EjDry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood CoN
Number of Structures:
b. Did the dischari*e 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?
❑ YesNo ❑ NA ❑ NE
❑ Yes ❑ NoNVNA
❑ NE
[:1 Yes [:1 No❑ NE
❑ Yes ❑ No NA ❑ NE.
❑ Yes ��Nq ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: gZ-- 725
Date of Inspection l2ClJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Oi� ❑ NA EINE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
ElYes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement? El Yes !J No [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes - No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VfNo ❑ 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 l0lbs ❑ 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) `` VS Ger c [:�.�//��N 016 �' 50"' (l rn .�I (O • :5-,
13. Soil type(s) /O ; 3D73 . M&C
14. Do the receiving crops direr From those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
O'C
❑ NA
❑ NE
Zo
❑ NA
❑ NE
LAN
[:1 NA
El NE
No
❑ NA
❑ NE
Comments {refer to question #�: Exp5ffi 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 nspector Name
�r Phone: YAO, 113,3: 3330
Reviewer/Inspector Signature:
Date: 8 -// — Zdp>3
Page 2 of 3 12118104 Continued

Facility Number: 1?Z —%Z Date of inspection
Required Records & Documents
F
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F-1NANE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �`NONA
❑ NE
the appropirate box. ❑ WUP ❑ Ch kl. is ❑ D . r_1 M r-1 r%.1'
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04
e1 �s esign aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
ther Code
Rain Inspections�NAM
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
A
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
❑ No
NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El
[ N
A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LI No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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?
El Yes
0<
❑ 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 ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

■
SLM-� EwA,--at 9-/S—z00? rzPL_
Division of Water Quality
Facility Number d Z ZS O Division of Soil and Water Conservation
O 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 deferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 9 � s� County: Ste/ Region: /%rte
Farm Name: C-7 Owner Email:
Owner Name: Gk—' -re— f y, -t3 Phone:
Mailing Address:
Physical Address:
Facility Contact: _Ciki-LS: �G �wt�C-K _ Title:
Onsite Representative:
Certified Operator:
Phone No -
Integrator: ktl &^-- S
Operator Certification Dumber:
Back-up Operator: Back-up Certification Dumber:
Location of Farm: Latitude: =' =' ❑ « Longitude: =0=6 = G
Design Current Design Current
Swine Capacity!.Population Wet Poultry Capacity Population
❑ Wean to Finish FE]Mn-Layei
Layer
❑ Wean to Feeder
Feeder io Finish $ D �
❑ farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle capacity Population,'.
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
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 `P No ❑ NA EINE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[�d No
❑ NA
❑ NE
El NA
El NE
[j Yes
[aNo
❑ Yes
`4 No
❑ NA
❑ NE
❑ Yes
rO No
El NA
El NE
12/28/04 Continued

y a
Facility Number: j Date of Inspection FT__ f - 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 4No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -6-7 it
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[4 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Reviewer/Inspector Name e. � Phone: V0 ,308
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
R No
❑ NA ❑ NE
through a waste management or closure plan?
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
W No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Yes
14 No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
QI No
❑ NA ❑ NE
maintenance or improvement?
❑ Yes
[;j No
Waste Application
❑ NE
18.
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[ No
❑ NA ❑ NE
mai ntenance/improvement?
El NE
11. Is there evidence of incorrect application? if yes. check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind. Drift El Application Outsideof Area
l❑
12. Croptype(s) %��drt C 47 1 ('_"0f/J
13.
Soil type(s) Aakyeer _ O%1�a/ , e• eit/
A
Reviewer/Inspector Name e. � Phone: V0 ,308
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[$ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[$No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
14 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[;j No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
� No
[INA
El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to hetter explain situations. (use additional pages as necessary):
A
Reviewer/Inspector Name e. � Phone: V0 ,308
Reviewer/Inspector Signature: e4.. �� Date: 9—f `2[36 7
12/18/04 Continued

T2 -7z $ 9,-/3-0T
Facility Number: g2 — Z Date of Inspection
Rees 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 appropirate box. ❑ WUp ❑ Checklistsgn
❑Desi ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2j No ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IM No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
[I NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
It] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IM No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

®Division of Water Quality
Fadltty Number �a�J,% Z 5 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit ® 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: [1-Z Arrival Time: II �'S0 Departure Time: County: _ S_.� Region: 14W
Farm Name: C-7 Owner Email:
Owner Name: C L,c %ri C 431 r, r �t�� Phone:
Mailing Address:
Physical Address:
Facility Contact: C�, S r k, Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =1 Longitude: =0=1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Laver T=�]
❑ Wean to Feeder ❑Non -Laver
® Feeder to Finish O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M
b. Did the discharse reach waters of the State? (if yes. notihr- 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
LINA
❑NE
❑ Yes
No
❑ NA
❑ NE
[:1 NA
0 N
❑Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[Vo
❑ NA
❑ NE
12/28/04 Continued

1<
Facility Number: FZ— 7�5
Date of Inspection-zs-D(,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes No
❑ Yes No
Structure 5
F-1 NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 27_
Observed Freeboard (in): Z/ g '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [.No ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [4 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 IO No ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tLl No ❑ NA [-INE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[]Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
I2_ Crop type(s) _ SPrM,4d� v-71 v t/_A 6rw-5-�� J
13. Soil type(s) !Y W F0 jL f o ,d+0 "1 /ia V-vt-til --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [29No [:INA ❑NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes ®No ❑ NA EINE
Comments (refer to question #):, Explain anyYES answers and/or any recommendations or anyother comments. _
Use drawings of facility to better eapb do situations. (use additional pages as necessary): '
Reviewer/Inspector Name F 1LK 1 -e VGt ; Phone: 0/0) 4Y&
Reviewer/inspector Signature: Date: dl —Z S - y (P
12128104 Confinued

a
1"acilih, Number: $2, —7 Date of Inspection "2S"=0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check []Yes N No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklistsgn
❑Desi El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ WeekIy Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No [:INA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
2&
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r7 No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[)D 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
91 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/lnspector 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
EM No
❑ NA
❑ NE
12128104