820472_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai
iiA)PA

P IDS bGt i-S
' rviston of Water Resources
Facility Number ®- {{7 O Division of Soil and Water Conservation
sQ Other Agency
Type of Visit: omplis ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: autine O Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: tM24 ounty: Si7-`q Regionf:?2'0
Farm Name: L/t{ 4k �^4 Owner Email:
Owner Name: Z:!�_ Phone:
Mailing Address:
Physical Address:
Facility Contact: c"G�(Title: Phone:
Onsite Representative: Integrator:
Certified Operator: t�`E'L�` 1{jYit f Certification Number: , 3 S eg
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design C•nrrent
Swine
Capacity Pop.
Wet Ponttr3'
Capacity
Pap
Cattle Capacity Fop.
Wean to Finish
Layer
FINon7Layer
Dairy Cow
Wean to Feeder
I
HDairyHeifer
Dairy Calf
Feeder to Finish
:1750
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D .. Poiil o'{I
Ca aci
P,o .
Non -Da'
Farrow to Finish
I
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
01=11Othei
Turke s
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
NA
❑ NE
' Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[0,Nk'
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E3<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
[ElNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[]No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120I S Continued

Facili Number: - Date of inspection: qC.
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-1qA7_ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Frceboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3- 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 E?lq_or ❑ 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 To ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6-190 ❑ 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 <71_ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[. 1`To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑YesWo
❑ NA
❑ NE
❑ 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 Drift ❑ Application
Outside of Approved Area
�Q❑
12. Crop Type(s): :6 ell ,/" y1t
13. Soil Type(s): CJa
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
e'No
�] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
es❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-3d st�
❑ NA
❑ NE
Reauired 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
1 =1 o
❑ 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
to
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
��
❑ 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
21412015 Continued

Facility Number: - Date of Inspection:
s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q-N-o___❑ NA
15. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QUO ❑ NA
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:
❑ NE
❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Q-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
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?
as
q:z 1-1 - t(0 Ott
e_ �. E �
CeY q (0 -3 D6� ff S (
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
a
❑ Yes
To ❑ NA
❑ NE
❑ Yes
[3'No ❑ NA
❑ NE
❑ Yes
ETNo ❑ NA
❑ NE
❑ Yes
No ❑ NA
0 NE
❑ Yes ❑ N
❑ Yes
❑ Yes 8No
❑ NA ' ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone C
Date: s Or Id
21412015

a- 101 c 7 .2,
Type of Visit: ^^ommpliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
C Reason for Visit: Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: C (o Departure Time: ; d County:
Farm Name: AA l + t Owner Email:
Owner Name: LUpl` too Va t (� t(V!12Phone:
Mailing Address:
Physical Address:
Regionj'_92-�
Facility Contact: 13 Pe✓`� -1 L C l Title: Phone:
!, Onsite Representative: q Integrator: W �9 " S
Certified Operator: 1 t )d d OL"T t.{r� Certification Number: r�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
MUMMUMBEEMNam
:�.i.
Swine
Wean to Finish
.- H,
Design Current:
Capacity �5 Pop. T?
Wet Pnul€a t�,
La er
DesEgoM.
Capacity
Current
Pop.
Design Carrent
Catilc @apacity Pop.
Dai Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other'1
Other
.i1G-uti�-n�
�;f.+.. "::'"
Non -La er
MUMd
D , P Dolt
Layers
Non -Layers
Pullets
Turkeys
Fur ey Poults
Other
— MPI�Ra:nw�sisa_�ise3V..'.N:ti.
�Desigti
Ca aci
;.u.li.-
Curnt
Po
'
:E.::.:.:
Dai Calf
Dairy Heifer
Cow
Nan Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
•k:s
E
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes D-Mo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Q-9A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No []-N'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 EJIffA {] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3-lGo ❑ 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 21412015 Continued

Facili Number: - -72- Date of inspection.
w
Waste Collection & Treatment
4. 1- storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0'Ro
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[J' ilgo
❑ 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
[j 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
L37 N-o
❑ 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
E'Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3No'
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej-1 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): c d el— 5 6 -0
13. Soil Type(s):
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 [:]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes [Po ❑ NA ❑ NE
[] Yes ZNo D NA ❑ NE
Repuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ 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
[3<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste "Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ei No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
d No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number; KT - -7 7 Date of InSDecti4n: ' b
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fro
❑ NA ❑ NE
25_ds the facility out of compliance with permit conditions related to sludge? if yes, check
[] Yes
[314o
❑ 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
E3<o
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/]nspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes [J'<o ❑ NA 0 NE
]Yes E31No ❑ NA ❑ NE
❑ Yes L—.I,'No ❑ NA ❑ NE
[] Yes [J"No ❑ NA ❑ NE
❑ Yes
�Vo
❑ NA
❑ NE
❑ Yes
E2"N-o
❑ NA
❑ NE
❑ Yes
[3"No
❑ NA
0 NE
Comments (r+efer to question #) ExplarnanY�ES�i uswers and/or any additional recomtuendations or.,apyother�,...codfirrieftszj
{;l t rj;
Use drawings ut.facl�ly, to bettejil
rexpla�n srtuat�onst(nse additioAal,pages as necessary). "
C'J� t'D_\ 1 b-17 1%
yWei
(��t ��sr
Reviewer/Inspector Name:
Reviewer/Inspector Signatuy
Page 3 of 3
Phone: RHO U3-3 "
Date: G^'T4
21412015

(Type of Visit: Q<ompliance Inspection Q Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: QKkoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: Departure Time: County: Region:
Farm Name: Al Owner Email:
Owner Name:�Phone:
Mailing Address:
Physical Address:
Facility Contact:" 1, t,C4,J Title: Phone:
Onsite Representative: C Integrator: F ty9
Certified Operator: (C.._UC Ad W e Certification Number: 158�p
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current Design Current
Swine Capacity Poll. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ca aci P,o
Lavers
Non -Lavers ers
Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes B-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 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 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ER No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

I
Facili Number: 72- IDate of Inspection:
Waste Collection & Treatment
4� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [jj-h*__0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ET -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 [ta-{d'if ❑ 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
Ef'�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
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
['!rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste Structures require
❑ Yes
[2 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
[ KNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [3 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): q3e M't'6_ SG o
13. Soil Type(s): (04 - !V D I ez � E-0-IC'C i, : (i e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
000o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
l;Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�Ne
❑ 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
[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
0 NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FaeWty Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff 3-No ❑ NA ❑ NE
Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [:]-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C3-tdo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hoursand/or document [] Yes Callo ❑ 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 E: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 E2-Ko ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes Q No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Fond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ WE
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 [2'/No ❑ NA ❑ NE
Comments refer to - oestion E lam an ::YES,ainswers andlor:iin adslrtronal recommendations or an o"n 'r CO invents.
Use;drawrngs'of facility tobetter:,;ex}tlam srtuado.ns(nse_addthanai.pages;as necessary): ;
/D- 30—If
7gc' pt5
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: C133-3m i
Date: ALM I 'b
21414015

Type of Visit: Uompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: EMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t Departure Time: County:
Farm Name: I��� - �-� 1 tr`0-, C '7,5 "l([- E _L_s Owner Email:
Owner Name: q Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: jftA 4(( Title: Phone:
Oasite Representative: Integrator:
Certified Operator: &e—? %tie Certification Number: 3 cS
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poaltry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Non -La er Dairy Calf
Wean to Feeder
Feeder to Finish
J1,17510
D jg Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
D , Paul Ca aci P,o , Non -Dairy
La ers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
I lBeef Brood Cow
Other
Other
DischarEcs and Stream Impacts
l . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E3-90 [] NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [:]No [3-NA' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No E],NX ❑ NE
c. What is the estimated volume that [cached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ffNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes {] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 21412014 Continued

Facili Number: cK JL_ - Date of Inspection: �7 t-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g-Mr--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [—]No Q_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
E3 N-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
Q-No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Cq-N'G— ❑ 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
ID"Kw ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P-No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [2'16o ❑ 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): a �� Z L;7~ S G 0
13. Soil Type(s): U A D I a F—e,C -e V , [ ( 6
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
®-N6
❑ Yes
[f`1 0
❑ Yes
10
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 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 �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F'acili Number: - Date of Ins ection: C
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [a-MV ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [e' ❑ 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:
X Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes C3-#(f' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [j 1� ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes O- o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0-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 [3�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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or OAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
E'"No
❑ NA
❑ NE
L' -90
❑ NA
❑ NE
LJJ No
❑ NA
❑ NE
No
❑ NA
❑ NE
(Comments (refer to quest on.M :Explain any YES•,answers and/or any additional.recommendations or attyiot�errcomments:
Use drawings of facility to (fetter explain situations (use additional pages:as nepnsary).
ReviewerAnspector Name:
(0- 3 0 - (�
MA
Phone: `,J
Reviewer/inspector Signature:
Page 3 of 3
Date: C
21412014

yx5 .9 .4oV Y ` -v
Type of Visit: (-J'Coroutine
nce Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: C) Complaint Q Follow-up Q Referral Q Emergency O Other Q,,Denied Access
Date of Visit: Arrival Time: ' Departure Tim e• County: SA M Region:
Farm Name: %'`� t�l { v 7 Z Owner Email:
Owner Name: N N �` t ; W� lJJ l Phone: � r6'-6'G
Mailing Address:
Physical Address:
Facility Contact: (3 r e%
Onsite Representative: f(.
Certified Operator: r
( 1U ( "t'{ Title:
Integrator:
Phone: _
4 /.?
Certification Number: O'17 S k 71
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentDesrgn
Current
Design Current
Swine "'
Capacity Pop.
Wet Po l ry'Capacity Pop.
k
Cattle' Capacity Pop.
DairyCow
We to Finish
La er
We to Feeder
Non -La er
DairyCalf
Feeder to Finish
tom: ^I"^�
. _ ';YT 1
De` sigh:
_
Current
Dai Heifer
Farrow to Wean
Cow
Farrow to Feeder
D . P,oult
r
.Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
., .
Other
Turkey Poults`
Other
Other
Discharses 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)?
❑ Yes []-tvo ❑ NA ❑ NE
[) Yes [] No
[] Yes [] No
o NE
Q NA ❑ N-E
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 [/No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

to A orc 10
acili Number: Date of Ins ection: '
Waste Collection & Treatment
4. 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 GJ44'7C ❑ 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 E3-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0-'Ko U 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 to Q NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [9-Mr�E] 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 NA ❑ NE
maintenance or improvement?
Waste Application
10- Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ff 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
i-V � g (/fto
12. Crop Type(s): r
13. Soil Type(s): U C
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
[]'Io ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E a-N' o ❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
01<0 ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Rio ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo [] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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 YNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acility Number: Date of Ins ect➢on:
�24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1SA"b ❑ 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 [ -%o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []-t6-❑ 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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ Yes C2r? o ❑ NA ❑ NE
❑ Yes [3<o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EfNo
❑ Yes / No
❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature:
Page 3 of 3

O'bivisio`n pf Water Quality
Facililivision of Soi! and Water Conservation
® Other Agency
Type of Visit: (zwomp ance 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 0 Denied Access
Date of Visit: Arrival Time. Peparture Time: County:hmo Regio .
Ro
j ✓
Farm Name: � l�i �<-I,t e � Owner Email:
Owner Name:^} Y Phone:
Mailing Address: C/ i 1 Hl(li�� `�1 b
Physical Address: 3 io m.,io S L,^ Avc
14 Facility Contact: t Title: �O( L4 Phone:
Onsite Representative: l Integrator:
Certified Operator: i/(rC Rotor- V Certification Number:5
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrenE
Design
Current
Design Current
Swim WGUacity Pop.
Wet Poultry Capacity
Pop.
Cattle ... Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult .' Ca aci
P,o
Non -Da'
Farrow to Finish ILa
ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Qther
Other
Disebar es and Stream Im acts
CO
L. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ED-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ ,NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWt)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LJ "'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 .21412011 Continued

_r
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-<oo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []rl o ❑ 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 [EL_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
®-1157
❑ 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
V5, - V
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2,Xh
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
(1, 115­
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E[,4Ki
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload D 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
A proved Area
12. Crop TYpe(s): / %il%9't 4� ��
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[21,'I�a
❑ NA
❑ NE
❑ Yes
[21�No
❑ NA
❑ NE
❑ Yes
[D-No
❑ NA
❑ NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes RV_o ❑ NA ❑ NE
[:]Yes [2--Ko­ ❑ NA ❑ NE
❑ Yes [j�-No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? if yes, check the appropriate box below. [:]Yes [e oo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E'Noo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes - Q�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:)Yes ❑G ' oo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes QoNo­ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes U31?5 ❑ 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 Q—Ko' ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately-
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Ep-ro ❑ 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 LJ'N0❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EKo /❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes To ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Io ❑ NA ❑ NE
(Comments (refer to question ,# )-. Explain any YES answers and/or any additional recommendations or any other commentsf-
Use drawings of facility to better explain situations (use additional pages as necessary).
c6J, �
- q33 33Reviewer/InspectorName:?')LL G �' Phone:
Reviewer/]nspector Signature: Q1 Date: ' U
Page 3 of 3 21412011

Ii ype or visa: Ly womnance inspecuon W qjperation Keview mrucrure Evawauon U i eenmcai AssistanceReason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f4 Arrival Time: (3 A+"1 Departure Time: 16 5 lqs AM-1 County: �An► bt�t1
Farm Name: (V �] F ` Va mi. j�'% As .j 24 a` Owner Email:
Owner Name: (Y U Ct )6y w £ Phone:
Mailing Address:
Region: Fol
Physical Address:_ tNoyAgw i=%11 Rc;A %,,•tz�_k
Facility Contact: _M c �h�t) Title: �tC�, �[)��ls�sPhone:
Onsite Representative: p, M i~ Integrator: MOJ
Certified Operator: [)(k jC_L Ko,; E _ _ Certification Number: �s S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desigh `l;arrent
DesignCurirent
Design Current
Swine
CapacEty'^Pop.
Wet Paltry Capacit} Pop.
Cattle Capacitg Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
' Feeder to Finish
�1 0
`�,�
Dairy Heifer
Farrow to Wean
u = gttDestgn�Current
D Cow
Farrow to Feeder
ltr � 1Ca- acitio-4q
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
a
Turkeys
Other':
.:
„�
Turkey Poults
Other
Other
Discharges and Stream lmoacts
I . Is any discharge observed from any part of the operation?
❑ Yes
fj� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
JZ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: a - 4 7 Date of Ins ection: 7 i q
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
Q NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ 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
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
© No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[yNo
❑ 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 Typc(s): A`_V. 6;? a r<.uop ( ua-1 Ptx,�ceQ� �. f�. e,.
13. Soil Type(s): �y n t r J V, Q t %d Ep c
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes © No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�j No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[►� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
&No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2f 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
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

41?�
Faeili Number: a' ): - jDate of Inspection: '7
/a
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[2�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
[TNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
dNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[yNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[!(No
❑ NA
❑ NE
Comments,{refer to quest,on # Explain any YES answers and/or any additional recommendations or any�oth rr-omnia-6
Use drawings of facility to better explsun. situations (use additional pages as necessary)..'' .`
N Et O S 11 oji�A�so;� Cv: o r� �n :� t: of "— N
-1t 1k'ZCtJ^-IDS ARE 3 ry CR4tR
_)PkA .5*%z+f•05@r4� lotr4R. Gulf
Reviewer/Inspector Name:
Phone: 510 - 3�SS•l�$�)
Reviewer/Inspector Signature:
Page 3 of 3
Date: `1 l 14 b 3'
21412011

Type of Visit: CO Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D7�Arrival Time: Departure Time: j i County: j _L Region: r)ee
Farm Name;� �� * , h t ���}.� Owner Email:
Owner Name: 4 f e {(r N C i J Phone:
Mailing Address: 11 .� 4­ 7 Ae U fsr-_%? Ir_J .i,:l' U t L26'%1SQG cc- - It' f,
Physical Address: m Q1 gel11 LEI
Facility Contact: �� f„T Inr4 Ott /� Title: LrA Slwc7'1%� r Phone: 9/ q .- 7.3 R 36Sq
Onsite Representative:
Integrator: Ae Ay
Certified Operator: & Certification Number: 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design, Current
Design Curren
Swine Capacity Pop.
_ Y r:uF-w
Wet Poultry ,._ Capacity Pop.
Cattle Capacity Pop.
La er
Dai Cow
Wean to Finish
Wean to Feeder
Non -La er
rt"-"
iry Calf
Dairy Heifer
�(
Feeder to Finish
Farrow to Wean
Design Curren
.
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
Other.
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:
❑ Yes 64 No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No © NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r
Facility Number: ] Date of Inspection: i/ arl
11
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): Is
Observed Freeboard (in): V�
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?
N
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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): (\jl p fl
V3 a vs , (3o b,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
M No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
M 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 [V 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 bQ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6]No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Y ,
Facility Number: jDate of Inspection: /Y ' , ,.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, cheek ❑ Yes No
the appropriate box(es) below. `
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List stmcture(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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No [] NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otliercZpnents.
„
Use drawings. of facility t6better explain situations (use additional pages as necessary). '.: , V .
Reviewer/Inspector Name: i ,r 1 t1 k A L-) S
Reviewer/Inspector Signature:
Page 3 of 3
EfI-4`16 -7SLt4
Phone: c1lC"33 -3 32'I
Date:
21412011

Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 41 Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 010 Arrival Time: idd i Departure Timer County: `F 7uv! Region:
Farm Name: — 1 49� _ Owner Email:
Owner Name: i ` 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: GWY Title:
Onsite Representative:
Certified Operator: 34
Back-up Operator:
Phone No:
Integrator: 'k 1in0 Lt�l'l i
Operator Certification Number: (�
Back-up Certification Number:
Location of Farm: Latitude: E� e = I 0 "Longitude: E] O =' I--] K
Design Current
. .: .
Design Current
Design C•nrrent
apaityPopulation
Wet Poultry Caty Poplation
Cattle. Capacity Plation
n to Finish
r1w
❑ La er
❑ Dai Cow
❑ DairyCalf
an to Feeder
❑Non -La er
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Ponitry -
❑ Dry Cow
Farrow t0 Feeder
-
❑ La ers
❑ Non-Dai
Farrow to Finish
Non -La ersPullets
❑ Beef Stocker
❑Beef Feeder
POGilts
Boars
❑ Turkeys
❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
❑ Other
INUInl0woctum
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
T NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes
1ANo
❑ NA
❑ NE
❑ Yes
r No
❑ NA
❑ NE
Page I of 3 12128104 Continued

a b
Facility Number: —
Date of Inspection O Ifl
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 Zcture 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 V
No ❑ NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance/improvement?
l 1. 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 Cro
p
Window ❑ Evidence o ind pt?514110)
rift ❑ Aplication Outside of Area
12. Crop type(s) lS�'h2�f u ` % ar. �nn. �I✓`
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
rfj No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ##): "Explain any YES answers and/or any recommendations or any oth6?comin n'�ts�
Use drawings of facility to better explain situations. (use additional pages as necessary): °.
/
Reviewer/inspector Name 42Phone:
10 3300
Reviewer/Inspector Signature:jx�majtaDate:
it D
12128104 Continued

a 4�
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
Po
❑ 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 El Checklists ❑❑ Design Maps Other
r
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA
Cl 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
T 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?
0 Yes
No
'R
❑ 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 Ioss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑Yes;No
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1� No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit *Compliance inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Complaint Follow up d Referral Emergency Other ❑ Denied Access
Date of Visit: 0 2Q 0 Arrival Time: Departure Time: �� County: SDI
Farm Name. M +� r � Owner Email:
LI
Owner Name: M UyPh, Y'Oi.JM LU_ Phone:
Mailing Address:
Physical Address:
Facility Contact: `' Q va . _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Region: W1_
Phone No:
Integrator: r " t l� 1'�W (q (-{ C
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =, Longitude: 0 ° = I = u
Design CI Nuol
Capacity Popultion
Design
Wet Poultry Capacity
Current
Population
Design Current
Cattle Capacity opulation
ean to Finish
❑ La er
❑ Dai Cow
ean to Feeder
❑Non -La er
❑ Da' Calfeder
to Finish
❑Dai Heifer
rrow to Wean
r(R)Farrow
La ersrrow
❑ © Cow
❑ Non -Dairy
❑Beef Stocker
to Feeder loin
to Finish
lts Non -La ers❑
ars Pullets
❑ Turkeys
Other ❑ Turke Poults
❑ Other ❑ Other
Beef Feeder
❑ Beef Brood Ca
Number of Structures:
Discharges & Stream Im acts
1. is any discharge observed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 K No ❑ NA ❑ NE
❑ Yes
❑ No
PiA
❑ NE
❑ Yes
❑ No
{RNA
❑ NE
❑ Yes
❑ No
P�NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
❑ Yes
ti�No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
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):
N
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 PZNo ❑ NA ❑ NE
❑ Yes ❑ No JD1VA ❑ NE
Structure 5 Structure 6
❑ Yes t�DlNo ❑ NA ❑ NE
El Yes " 9No ❑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 o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes TNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance/improvement? !!!!
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Win rift El Application Outside of Area
12. Crop type(s) [�"//TT05 �-f cJY�i r Q2.it D 13. Soil types) 1("m "&& hb of k — a 1 htw(U44 -�hg) CP�i'/l ` e -Rc-
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
MNo
[I NA
[:I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E iNo
`�
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments(refer to ueshon # . Eg' Isin any YES answers and/or an recommendations or au'�.other comments.
Use drawings of facility to better.explain situations. use additional pagesas necessa
�
2
Reviewer/Inspector Name Phone: 7 '✓
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection i 9 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1! ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes ENo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Chccklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 8PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ANA ❑ 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
F9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[;iNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)KkNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�TVo
❑ 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
5INo
❑ 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
SbNo
❑ 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
IgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EkNo
❑ NA
❑ NE
12128104

- -- � Division of Water Quality !�
===Tae'Humber -� `]' Q Division of Soil and V1'ater Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time:
Farm Name: jlifa Own
Ai
County: Region:
er Email:
Owner Name: IA*—12rair1. L.LA _- Phone:
Mailing Address:
Physical Address:
Facility Contact: '1 Title:
+t7
Onsite Representative:
Certified Operator: jW`y+
Back-up Operator:
Location of Farm:
Phone No:
Integrator: "®rogn CLC-
Operator Certification Number: 98�a,6
Back-up Certification Number:
Latitude: = c =' = u Longitude: [�] ° =
Swur
;tee
Design
Capacity
Current �'� � :Destgn Current=- _ Design Current
Papulahon__ Wet Poultt y Capacity Pop Ishont: Cattle Capacity Popnlation
❑ Layer I I la El Dairy Cow
ILI Non -Layer El Dairy Calf
$ ❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
o ❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non —Layers a ❑ Beef Feeder
❑ Pullets
❑ Turkeys ❑ Beef Brood Co
f` ❑ Turkey Poults
❑ Other - Number of Structures:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
1000
❑ Farrow to Finish
❑ Giits
El
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
BNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
DNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IRNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
`® No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

f
•'Facility Number: — Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
? No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
ier:
Spillway?:
Designed Freeboard (in):
k
Observed Freeboard (in): C30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
&No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No [I 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
EpNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&NO ❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Mt4o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) ` 1 -
tW �X�'Vi
�J� _ &a.(,,
.,
_
13.
Soil type(s)j
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
J1No
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
MNa
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�INo
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
' QNo
❑ NA
❑ NE
Gomme�{refer to qu�hauu;#) E�ilaun anyf answers anorr,� nec�o�mmEndattons�or any other comments.
Use drawutgs of facili�ty���kta+better�eacplasn sitivat,iions'{use7additional�pages asy�oeeessary}:
Reviewer/Inspector Name Phone: 49 ffL3 r 3dO
Reviewer/Inspector Signature: Date: U
Page 2 of 3 12128104 Continued

• T
Facility Number: 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes (No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
U No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1qNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
nNo
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
nNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O=No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JgNo
❑ NA
❑ NE
Other Issues
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
V14,28.
ge No
T�
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
ElNE
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
F5No
❑ 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
SNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PINo
❑ NA
❑ NE
Additeonal{Coml ieuts antil/or -
.,..
Ll
Page 3 of 3 12128104

Division of Water Quality
Facility NumberMK��] O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Arrival l ime: ��Departure Time: 0 County: S Region: 17620
Farm Name: Owner Email:
Owner Name: "VI Phone:
Mailing Address:
Physical Address:
Facility Contact: CA,- r Title:
Onsite Representative: %(
Certified Operator:
Back-up Operator:
q/� Phone
jD
No: Q
Integrator: /'' i u,., Ybt,,) &n
Operator Certification Number: c� 114(o4
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = , ❑ Longitude: ❑ ° ❑ I ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1' ID Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Curre.ntx
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef $rood Co
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 OIo ❑ NA ❑ NE
❑ Yes
❑ No
FPNA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
)RNA
❑ NE
❑ Yes
TNo
❑ NA
❑ NE
❑ Yes
49No
❑ NA
❑ NE
12128104 Continued

+ Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
❑ Yes I&Nc
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
�JNA
❑ 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 .p No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
b_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes 4P 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 Olo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 15L 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
El NA
❑ NE
maintenance or improvement?
J
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 1ANo
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�No
El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 1w' fYi S ( t
13.
Soil type(s) go t �R ti ° A t VJO.'b
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
QMNo❑
NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
�] No
❑ NA ❑ NE
lb.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
1P No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application'? ❑ Yes
PNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
N No
❑ NA ❑ NE
Comments (refer to question 4): 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 {�l�tri<j Phon • fa �{ 3 3 OD
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropiiate box. ❑ wUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W 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
IR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ip No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EP No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FP No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TNo
❑ 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
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

1
[Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit 4P Routine d Complaint 0 Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: '1�� Arrival Time: 9 '_-0J4 " Departure Time: `� County: _ r►YJ.ST Region:
Farm Name: { }� Owner Email:
Owner Name: _ P 6VID ` &A Phone:
Mailing Address:
Physical Address: Facility Contact: �7��� GI—C _ Title:
Ir
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine..
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
g'L1 Farrow to Finish
❑ Gilts
❑ Boars
Design Current`s
Capacity Population!
Phone No:
Integrator: J `�j� I &A4 fow ln
Operator Certification Number:
Back-up Certification Number:
Latitude: o u Longitude: o
©ry Poultry
Other ❑ Turke POLlItS
❑ Other ❑Other
Design Currents
Capacity Population
. U Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
. 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 Stale? (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?
Page I of 3
❑ Yes [PNo. ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
fiP No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number:
Date of InspectionI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[)9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E2No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
S
Structure 6
Identifier: 14
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in): (n 3 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
0 No
❑ NA
❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
&. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
T No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
TNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[--]Yes
k3No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wfind Drift El Application Outside of Area
r
12. Crop type(s) - t o�5 4 &'f � P� S ), 7'-
-
13. Soil type(s) I B t EQCP. V i( if 1N 041 ija. 8
1,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q?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
[B No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
g] No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ER No
❑ NA ❑ NE
Comments {refer to question #): ExVIVESIanswersiangtorang recommendations or any other comments.
Use drawings of facility to better explain si#uatiottS. (use additional pages as necessary}:
Ah
w
Reviewer/Inspector Name �Im t 0, Phone: _ ?l8 E(33-1100
Reviewer/Inspector Signature: Date: $rG5"*o,6
Page 2 of 3 12128104 Continued

1
Facility Number: Date of Inspection 1�7J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ` U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�9 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
M) No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ 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
29 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
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
99 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or. Drawings:
Page 3 of 3 12128104

,I
Type of Visit 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit b Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: = Departure Time: County: Region: l�lZO
Farm Name: ( Li '�L. Owner Email:
Owner Name: ^. M t a LJ j Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:... � � �r 4
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.Other
❑ Other j
Phone No: - 1
Integrator:
Operator Certification Number:g `
Back-up Certification Number:
Latitude: =0 0, ❑„ Longitude: =o=,
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
Non-L
Pullets
Puults
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
❑ Daja Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non- Dairy
❑ Beef Stocker
❑ 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)?
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 V .No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
LINE
❑ Yes
❑ No
% NA
❑ NE
RNA
❑ NE
❑ Yes
❑ No
❑ Yes
�LNo
❑ NA
❑ NE
❑ Yes
�6No
❑ NA
❑ NE
12128104 Continued

acility Number: ,'Z —
Date of Inspection �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
Identifier: �1
Spillway?: VL D
Designed Freeboard (in): - Qr
Observed Freeboard (in): (dj
Structure 4
❑ Yes 1;j No
❑ Yes ❑ No
Structure 5
El NA El NE
P NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
r
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J4 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
gNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V.No
❑ NA
❑ NE
maintenance/improvement?
1 I . 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 ❑ Application Outside of Area
12. Crop type(s) � ;,,.tip r�t� - a r r� i c? - . — u �
— -
13. Soil type(s) Id,Fz ce--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! El Yes �(No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 91 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 sitttatioas. (nse additional pages as necessaryj:
Reviiewer/Inspector Name ,s, a, �, , $ ► Phone: `f 6X_ 47 ' 15tV
Reviewer/Inspector Signature: Date:
1 12128104 Continued

Facility Number: — Y Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 7No ❑ NA ❑ NE
the appropirate box. ❑ VrUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�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
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6"No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes C9,No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 91 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 �S,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 RNo
❑ 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 X� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes Avo
❑ NA
❑ NE
Additional Co'snments and/orDrawings:
12128104

� ki .mx a »a..,
x
- z a5,; a� arm �,.,. ' i - _ _ � -' �F - �� ,�.. •r.t - �.'..'� ��t Ya�.gj..',, a � - - . ,.
DSW An>mal Feedlot "Operation Review
a .., f,
s
DW Anliriat In
a
gFeedl0 Meratlon pection x
❑ s
;^
d Routine 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other
Facility Number
Date of Inspection ®7 4- 17
�- �
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑"stered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review i
L1l'C.ertilled ❑ Permitted or Inspection includes travel and processing)
❑ Not OperationallI Date Last Operated: .-----
Farm Name: ,_�.. Z ..._. — - --_ ...... .... County: Q S r.... _....... _
Land Owner name: ��1 O L
... Phone No:
Facility Conctact:.�..�k SwL ..._ .... _.... Title: [�rl,._.,.�< c- Phone No:
MailingAddress: .... .... .r... ._....... �_.. _... _ ............... .... _...._.._....... ..... ......... .................. � ».. _.............. �._.� ...
OnsiteRepresentative: A ... t...__..,._._...... ...._ ............. ..... _ Integrator:.
Certified Operator: Operator Certification Number:
Location of Farm: P ✓L S : d t.- A/C S Z / 9 D 6 ti 0, -F /i_ A400 /ti r r.,, ZZ- Ales-P / 9 J 4
Latitude ' C u Longitude ` 6 64
Type of Operation and Design Capacity
- u w ±e5162
€{CilrCeitt�^ n�� r% DCS�R xCUrreDt
Design Cnrreat "4, : g,
x+:s,5 wiT ° st tom.. Pattte�MPo ulr a o 9ci £e Pow,wu;e
laion lti
❑ Wean to Feeder ❑ Layer ❑ Dairy
r
FRO Feeder to Finish � !]❑ Non La er 10Non-Dairy
F
Fxrow to Wean�Mq�
arrow to Feeder 3Total Design Capaei€y h
Farrow to Finish & U ay.;Z
❑other ���� Total SSL��V� � t �,
.MINI I I �� sf' +frsaa sy,
NumberofgLagoons�! HoldinglPontlsv Subsurface Drains Present
"Lagoon Area y
❑ S ra Field Area
_
Gencw
I . 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 obsen ed, did it reach Surface Watet"? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rnin?
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
4/3 0/97 maintenance/improvement?
❑ Yes E1dI
❑ Yes [2<a
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑No
❑ Yes
Lt 1(010
ElYes
VNo
Yes
Continued on back

Facility Number: ...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
a-T4110
7. Did the facility fail to have a certified operator in responsible charge?
© Yes
B+
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
B, o
Stru tors (Lagoon. and/or [jolding PgMdsj
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
9<0
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
1 t)_ Is seepage observed from any of the structures?
❑ Yes
B<o
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
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
�lo
Waste APPlication
14. Is there physical evidence of over application?
❑ Yes
Ev4
(If in excess WMP, or rrunoffentering waters of the State, gotify DWQ)
jof
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
gkl Io
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
�o
18. Does the receiving crop need improvement?
❑ Yes
O No
19. Is there a lack of available waste application equipment?
❑ Yes
20. Does facility require a follow-up visit by same agency?
❑ Yes
�01
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
_�
El No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
d No
24. Does record keeping need improvement?
❑ Yes
No
Comments refer O' estion Ex lam an YES answers and/or an reconunendations or an other comments"
(. 9u ., p Y Y x y e �o , ,
Use -".-
pages as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ZLO
cc: urvrsion of rrarer Lruaa)>, warer VuarrrY .3ecnon, racurry Assessment unu 4/JU/V

Site Requires Immediate Attention:
Facility No. '
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: sL141 Z 1995
Time: ' v 9 M
Farm Name/Owner:
C �r�f�
Mailing Address: G. t�,0 w6t$ 5�� W'ffz S#w
County: Sampson _
Integrator: earroll Foods Phone:
On Site Representative: non LaCoe Phone:
Physical Address/Location: 04Lr
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site: 6 6 S W 5 N/
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ys or No
Was any seepage observed from the tFor
(s)?
Is adequate land available for spray? No
Crops) being utilized:
Ac Freeboard:�Ft. Inches
Yes or &Was any erosion observed? Yes o6�
Is the cover crop adequate? SY s or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings' Yek or No
100 Feet from Wells? [ems or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or to
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate was management recur (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (YeA or No
Additional Comments:
_ D , fT _JG_f/t 5
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

S
JUL 14 ' 55 11 : 46PM
WORTH CAROLMA DEPARTl 2M OF ENVIRON=, HEALTH & N7A=iAL RESOURCES
DIVISION OF ZWMONiLs NM MANAGE
Fayetteville Regional Office
Animal operation Compliance Inspection Forn
FSR2S 14i1 fK'/OWN= ;'.,.
MNSPEGSIQN S?ATgY;w
PAF12i' ITT@ A
�--
CAR2bt1..s Iiiv-iEts c.
W clL-
-P.D-jg%ggR Ss6 MS:L4 C'. 9
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
&—limal Operation Tyi>e:
Horses, cattle'�� poult_= or sheep
ficIONTI
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head) ,
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)] - •
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a XWDML
WAS GEKZNT PLAN?
S. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?
KO0 a �.

jUL 14
iSF'CS34?4 IS I
'f
F r Y N CONS
Field Site Mg_naceme_It
1. Is animal waste stockpiled or lagoon
cazstr,=tion within 100 ft- oy a USGS
Nap Blue Line Stream?
2. is animal waste land applied or spray
Irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
On which to apply the waste?
4. Does the land applicati©n'site have a
cover c-rop in accordance with the
MTIFICATTON ?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(S;Lm) of the approved Cz:RTIYICAxxpN?
7. Does animal waste lagoon have sufficient
freeboard? How much? {Approxiaately }
6. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
sr=roN ry
Comments

-, '1 Jl— i
am ", - - ,q i 0 � C 7 -� � :