090017_INSPECTIONS_20171231

t
Type of Visit: ("Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 EmerRencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 O Departure Time: �t7 County: Region:
Farm Name: Owner Email:
Owner Name: ! f Phone:
Mailing Address:
Physical Address:
FacilityContact: �>r Yrr /' Title: G• G Phone:
Onsite Representative: Alpzl f �I.,. _ Integrator:
Certified Operator: l%rsti Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop. _M
rHIM
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I Layer
EWig Cow
Wean to Feeder
loD
Non -La er
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,nultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
jBeef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Turkeys
4
Other
�a __
Turkey Poults
Other
Other
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q 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 DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a<//o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Hj o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - jDate of Inspection:
—)
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
❑ Yes
Q
❑ 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): ,/ 9
Observed Freeboard (in):�`�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0No
❑ 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
[DNA
❑ 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
[3o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'iVffio
❑ 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
[Ef'f o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
4
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ED"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 l❑ Application Outside of Approved Area
12. Crop Type(s): 3r/z kJa ZOv�zi-rYGt
13. Soil Type(s): t-A -r -wi —
14. Do the receiving crops differ from those designated in the CAWMP? 107
D Yes
Q'14o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
<o
❑ 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
[!J' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(2-Ko-
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[J-Ko
0 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [aqo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑-Ko ❑ NA 0 NE
\age 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: - --/ell
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ees ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Von -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 [E]�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3No ❑ 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?
0 Yes [3 <o ❑ NA ❑ NE
[] Yes [E Io ❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
❑ Yes [3- o ❑ NA ❑ NE
[:]Yes [ "No
❑ Yes E44
❑ Yes [-'<Va
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
( ter to gfiestion;#�: Explain any�YES answers and/or any additional_ recommendations, or any other cote is:_i .s Comments re
Use'drawEngs'offacili tuibetter ex lain situations, yse4. itional es. as necessa 3
ty h c l ��
Reviewer/Inspector Name:
ReviewerAnspector Signatui
Page 3 of 3
Phone:
Date:
2/4/201 S

ft
Type of Visit: r,�,+'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outiue O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f —J Arrival Ti e: Departure Time: ,' D County: L,a, a I Region: ./Rb
Farm Name: Owner Email:
Owner Name: �iz��-�— Phone:
Mailing Address:
Physical Address:
Facility Contact: r.-Y d ��d%f//� Title: � 77 r&.-4
Onsite Representative: z
Certified Operator: 7_y r z-L,,, --
Back-up Operator:
Location of Farm:
Latitude:
�__C, Phone:
Integrator:
Certification Number: /v�
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity F Pop. i�VetPotiltry., Capacity .. Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Design Current ;
Ca aei I;o
Dai Cow
Wean to Feeder
/(�
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D P.oultr •
La ers
DairyHeifer
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
M
Other
TiirVexic
Turkey Poultser
,`;
1
I i
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes IWo ❑ 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes LNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes UNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

4 Facility Number: jDate of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E; No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?: fr
Designed Freeboard (in): Z 427' Z?-
Observed Freeboard (in): 13 r �3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[4 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?
0-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
Pa:_No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes C3,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 OutsideofApproved Area
t 2. Crop Type(s): se-L/l7Y.Kt 4 _ /Dcr�✓� r-r� 1'y19 1��/ �r`I� f�J�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ELNo
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[V_1 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
0 No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
q No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
[2. No
❑ NA ❑ N E
❑ 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
allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes 0 No ❑ NA [] NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6INo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ Yes E@ No ❑ NA ❑ NE
❑ Yes 5;TNo ❑ NA ❑ NE
❑ Yes RJ No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
M No
❑ Yes
54 No
❑ Yes
[21 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to�quest,00 #� j iplain'anny YES answersland/or any-additidnai�rreceommendations or any other, caminrnots�
Ilse drawings of,facility,;to. betterexp.largsrtnations (use;additional pages;;as necessary)" °'
/L-
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: UMompliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: autine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — , / Arrival Time: , 3 a Departure Time: Q ,' a County: L/_ Region:
Farm Name: � ,� ro_t�3C2.5 / . r Owner Email:
Owner Name:td lee v-- Phone:
Mailing Address:
Physical Address:
Facility Contact: 11Title: e9-wn Phone:
Onsite Representative: Integrator: �r�/.�—
Certified Operator: !� f /� 11�..� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Cnrrent
Swine
C►apRE Pop.
Wet Poaltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Isa
Layer
Non -La er
I
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P■oul#r
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
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:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D)VR)
c. What is the estimated volume that reached waters of the State (gallons)?
[-]Yes JE. No ❑ NA ❑ NE
❑ Yes
[:]No
[] NA
[] NE
❑ Yes
o No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes S No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 125-No ❑ NA ❑ NE
of the State other than from a discharge?
LPage I of 3
21412014 Continued

Facili Number: © - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑- No
❑ NA
❑ NE
(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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
SNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Aptcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): El sr v r W -a.TY S1+ rr
i3_Soil Type(s): /-a-/C',1a.'d /'X�,"/ P/4��u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RLNo
❑ NA
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5-No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ 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 ENo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Eg-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E]-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [&No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes ELNo
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?
Use drawings of`tacility to better a plain°situations (use.additional;pages as
1
Reviewer/Inspector Name:
��—
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes 0,No ❑ NA ❑ NE
[—]Yes EjNo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes E[ No ❑ NA ❑ NE
❑ Yes
ESNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
Eg..No
❑ NA
❑ NE
Phone: -,C)
Reviewer/Inspector Signature:��J~ — Date: g
r ✓T
Page 3 of 3 21412014

H
Type of Visit: om 'ance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:� Arrival Time: : 3 p Departure Time: L County:
Farm Name: 1 llk 't ��/5 Owner Email:
Owner Name: �� F 2zt' d 3 �7 �Irv� Phone:
Mailing Address:
Physical Address:
Facility Contact: �Ae ✓ %h'CYJ�`^c- Title:zie'el-A5
Onsite Representative: X& Z2
Certified Operator:
Phone:
Region:
Integrator: j12--25 sr �
10,
Certification Number: /6�(d�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Carrent
Swine
Capacity Pop.
Wet Poultry
Capacity
:Pop.
Cattle
Capacity Pap.
Wean to Finish
La er
D ' Cow
Wcan to Feeder
/ 160
Non -La er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D P�oul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Turkeys
Other
s _
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes VLNo ❑ NA 0 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

i
e
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IZNo
❑ 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):� ) Sr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tA 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
ELNo
❑ 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
fg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
a 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
Ca No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [EkNo ❑ 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): 'z►�' << %i­'; y � � 1177 F l/-, 1_1VV -4
13_ Soil Type(s): 1_11�`___ '/ka.;nj / "�<ruc�
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 RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes [RNo ❑ NA ❑ NE
[:]Yes B—No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ 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
Callo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Z 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 JZL No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Vj No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4a No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ®, No
❑ Yes E"o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to 6 lion # Explain an ::YES, { swers and/or any
pages additional rercyo)fi�uendations or.an other comments.
( q ) p Y Y Yi,
Use drawufiof facilr to better ex lam .situations use additional as 4necessa
1 �GD+tI�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 9—/ �'6 /-:�—
21412014

Type of Visit: OrCompliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint p Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: - y—�!� Arrival Time: ID,'� �� Departure Time: ' County: Region: �,}7'>
Farm Name: A t I � � � f D��'S �Qi/t.�. Owner Email:
Owner Name: 7 Phone:
Mailing Address:
Physical Address:
Facility Contact: �Nz-r./jXj Title: Phone:
Onsite Representative: 13*7_1._�� Integrator: Ar'4
Certified Operator: , Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_'M~
�
'g ent
Dest n Curr
Design,�,,Current01
EDeiic,wine
S
Capop.
Wet Poultry
Capactty P p
Cattle ity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_ 7 ` :
Dairy Heifer
Farrow to Wean
Design current '.
D Cow
Farrow to Feeder
D . sP,oult .
Ca acre*Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
r ,...
Other
. , _ .
TurkeyPoults
Other
:..
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes
ENo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
[—]Yes [:]No
[—]Yes gg�No
0 Yes ®, No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: IDate of Inspection: --
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Frr"4—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
n No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
KNo
❑ 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
El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O No
❑ NA
❑ WE
(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
C�LNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): / r —
13. Soil Type(s): Id / 1 e;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
g No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gj No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
23,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
E! .No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C�S_No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes &I No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes E, No
[—]Yes ®. No
❑ Yes ZjNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to,question 9): Explain any YES answers and/or any additional recommendations or any -other comments: -,
Use drawings offacilityto better explain situations (use additionalpages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/d—�__��.3,3aO
Date:
21412011

I
e
Date of Visit: Arrival Time: t `(7O Departure Time: 4 ; a County:, Region:
Farm Name A11,-•-L 273 r ov-j 6")-,,. _ Owner Email:
Owner Name: Al leµ- Phone:
Mailing Address:
Physical Address:
Facility Contact: tSrL'Y/ /use /�[r Title:
Onsite Representative: 'Sp•-.�
Certified Operator:p-s•>����T-var
Phone:
Integrator: �rr5��1r—
Certification Number: /to a2 (�IS-,'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
tip;-± -x..,U Design Current
Design Current Design Current
ASwine Y Capacity Pop.
Wet POnitry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder
VV 110
1 VIM
Won -Layer
Feeder to Finish"_.
DrvPoultryCa
-
Design Current
aci Pao
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
L_LOther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? ([f yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes MNo [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
Page I of 3 21412011 Continued
-yam

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
❑ Yes
[N 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:fi r.
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): �L 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
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
[Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R 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
[R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[2�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
EA -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): Zn6jrIAOL&:='l
13. Soil Type(s): 1-0-,- _ / ZiaY .z�/ l 6'Z" Zra-_
14. Do the receiving crops differ from those designated in the CAWMP? loor❑
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
IS No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
54 No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z.No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® 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
R,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QS-No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - J Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes Reo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
JOLNon-cornpliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 9 Dc:) _
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [&No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No ❑ NA ❑ NE
[:]Yes [Z No ❑ NA ❑ NE
❑ Yes CZ[No ❑ NA ❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
❑ Yes
VK No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
.. her comments& �=_ Ue'74'ralwines,of
mments (refer to question # Explain ,any YES answers and/or any additional recommendations or any.ot
facility to better exolain situations (use additional owes as necessarvl. ry .. 3i.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Date:
21412011
Page 3 of 3

Type of Visit: omm�pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0-f outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
121 Arrival Time: f D
Departure Time: p
County:
�F
Farm Name:
/T�z^i� B to",
f=, f',
_ Owner Email:
Owner Name:
r,-t'J_ J
Phone:
Mailing Address:
Physical Address:
Facility Contact: �g /�,� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator: Y `"5
Certification Number:
Certification Number:
Longitude:
Design Current
_ Design
Current
Design Co."
Swine Capacity Pap.
Wet Poultry " lCapacity
Pop.
Cattle Capacity Pop.
Finish
Layer
Dai Cow
Feeder p
Non -Layer
Dai Calf
Finish
r
`'
-
Dai Heifer
o Wean
Design
Current
D Cow
o Feeder
D Pboultr Ca achy
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turke s
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)?
d. Does" the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes Q4,No
❑ Yes PS -No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 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: Ta'k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L;J
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
[S 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
El No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes
rut
❑ 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
[allo
❑ 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
15 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 ❑1Application Outside of Approved
of Wind Drifter
Area
enEvidence
�j❑
12. Crop Type(s): if)t'1o_ /fir ,,,d► / ! ", '� I
13. Soil Types):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(ul No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[allo
❑ 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 EK No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r'ZA No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ragffoF ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[gNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: r I/ —AbC)
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes
L&No
❑ NA
❑ NE
❑ Yes
ZLNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Use drawenes of f i Hitv'to better ex6l in situations (use additional naies'as neccssarvl:
Comments refer to uestion Explain an YES answers and/or an additional recommendations or any other comments;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: �}"%l?`Li��'3��
Date: as �t—i#���
21412011
Page 3 of 3

A
Type of Visit: JarlMoinipliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: f (7 County: Region:
Farm Name: ,fttv Qr/yr, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / 9 Z269yyf Title:
Onsite Representative:
Certified Operator:
e. Phone:
Integrator: 01'-' 2 �e
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
,' +.�'� ����Dgn Current li ,_,- Design. Current
Design Current
Swine ,Capacity Pop. Wet PoultryCapacity Pop.
Cattle
Capa06Mcdonity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
airy Calf
Feeder to Finish
W.
Dairy Heifer
Farrow to WeanDes�`1n
Current
Dry Cow
Farrow to Feeder
D . 1P.ou1 �a Ca 'aci _ I'o
La ers
Non -La ers
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
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? ❑ Yes Eg-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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
j� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): `g /
Observed Freeboard (in): 3a�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 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
2jNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ 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 Barc Soil
❑ Outside of Acceptable Crop
//Window ❑ Evidence of Wind Drift `❑ Application Outside of Approved Area
12. Crop Type(s):Ka
t�Y'sr�—�l
13, Soil Type(s): La��- Ica-r� l� a7,-t 5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [T No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [Z No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [k No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes Wj No ❑ NA ❑ NE
the appropriate box. �'
❑WUP El Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RA No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[]NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA [] NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 54 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
[:]Yes No
[:]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer mquestion ft Explain any -YES answers-andlor any additional recommendations"oriany�other�commi n_ s 0
= - -
Use drawings of facility to better explain..situations:(use additional hazes as necessarv)."
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3
Date: l�
21412011

Type of Visit UCompliance Inspection Q Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit (! Koutine O Complaint 0 Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: D Arrival Time: Departure Time: // : 3 (� County: Region:EEC)
Farm Name: Owner Email:
Owner Name: Rahhn l/j 7T I /e—_YL. Phone:
Mailing Address:
Physical Address:
Facility Contact: OKfA Lad l %art Title: w" Phone No:
Onsite Representative: — _�� ��'�/`r�C�%i�G�7r'c. Integrator:Lac�
Certified Operator: -- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [�J o = ' = u Longitude: = 0 0 A =
it
Design
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Layer
��
❑ Dairy Cow
❑ Wean to Feeder12�JOO
1 1[] Non -Layer
I
Dairy Calf
I
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ La ers
Beef Stocker
Non -La ers El Beef
❑ Pullets ❑ Beef Feeder
El Turke s ❑Beef Brood CoVA
U#her
❑ Turkey Poults
❑ Oiher
Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
53-No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [S 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): /9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes (3No ❑ 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 [9 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 SNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 Ibs ❑ 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)`m�
13. Soil types) ��ja� /KQ,
v
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
5'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5jLNo
❑ NA
❑ NE
-� s•-ems ,-
Use draw ng`s`of facility to better aplaan situat,ons (use addtfaoit asneces aary)ns or any other coents.,
E.�r
.:
Reviewer/Inspector Name i i , 'a w t1 Phone:
_
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 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
CRNo
❑ 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
Z1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9 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
J.No
❑ NA
❑ NE
Additional Comments asidfortDrawings-
a
w
Page 3 of 3 12128104

A
Type of Visit tK Compliance Inspe on 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Complaint 0 Follow up 0 Referral 0 Emergency 0 other ❑ Denied Access
Date of Visit: It =1j Arrival Time: , c2 Departure Time: k30 I County: Region: d_ go
Farm Name: 21 l k.-LY✓�` _ _ _ Owner Email:
Owner Name: Q _� Il�%L Phone: 73 t,L? S� b
Mailing Address:
Physical Address:
Facility Contact: AP/L Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =' =" Longitude: = ° =' =
Design Current
Swine Capacity Population Wet Poultry
Design Current
Capacity Pop li tion
Design Curren#
Cattle Capacity Population
❑ Wean to Finish ID Layer
I
❑ Dairy Cow
❑ Wean to Feeder
I ILI Non -Layer
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
[I Farrow to Finish El Layers
Gilts ❑Non -La Non -Layers
❑ Pullets
EE:]Boars
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Points
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 'CFI.No ❑ NA Ad"
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ NA
❑ N
❑ Yes
❑ No
❑ Yes ;.No
❑ Yes 1_-21�0
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
29-NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
M NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
RNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
(A 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
0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
WNE
(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
KM
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
g No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ji=rWJdj d,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IN No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
JnNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
M'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Phone: U` 9 - 0 1151
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

Facility Number: --- f Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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.
❑ WUP ❑Checklists El Design El Maps [I Other
❑ Yes ❑ No ❑ NA 9 NE
❑ Yes ❑ No ❑ NA (1. NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA DINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocldng ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
MCNE
❑ Yes
❑ No
❑ NA
J9 NE
❑ Yes
❑ No
❑ NA
QNE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
E,NE
❑ Yes
❑ No
❑ NA
C(NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA CXNE
❑ Yes ;ElNo ❑ NA ❑ NE
❑ Yes (;MNo ❑ NA ❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
AddttionalsComiaients;and/or
%GUD I ke / 28,7t'%+, r
r rl� /JO �5
12128104

I
Type of Visit (D-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit GrAGutine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3�,✓ Departure Time: / County:
Farm Name: %�I�t i _ 7 X/0'U" Owner Email:
Owner Name: !!/�►'t-- Phone:
Mailing Address:
Physical Address: /�
Facility Contact: Zffin si / � Title:
Onsite Representative: e
Certified Operator: ��•�f/�''t
Back-up Operator:
Region: 1EX 0
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =1 Longitude: = o = � [= u
Design
Current
U
M_ .70e
Cnrrent Design Current
Swine Capacity
Population
Wet Panitry�'Capactty
❑ La er
❑Non -La er
" .fit!'^
Population Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
ElDai Heifer
❑ Wean to Finish
'Wean to Feeder /
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultyy -� g
" ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -La yers
❑ Pullets
❑ Turkeys
❑ Beef Stocker
❑ Beef Feeder
El Beef
Brood Cow
Gilts
P1:1Boars
Outer
M—Turkey Poults
❑ Other
'._ .Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
❑yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility ]Number: q' — Date of Inspection -v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[I Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 1- 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
BNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[-]Yes
JgNo ❑ 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
CKNo ❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
KNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M-No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 ] 0 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) Zi 1/:
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? "
❑ Yes
JRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EKNo
❑ NA
❑ NE
1 S. Is there a lack of properly operating waste application equipment?
❑ Yes
&3-No
❑ NA
❑ NE
Cominents'(refer to yuesteon #): 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) Y
"� +�
0X*,_yV1_W
Jam/ / Ws�� Cl1ri!
Reviewer/inspector Name --
�Y� Phone: �33�L0
Reviewer/Inspector Signature:
Date:
Page 2 of 3 - 1 12128104 Continued

Facility Number: q — 1 7 Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IN No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
54 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
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ 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
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 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
54 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
51No
❑ NA
❑ NE
Page 3 of 3 12128104

an
ion of Water Quality S//&;1
Facility Number 2�� Q Division of Soil and Water Conservation
Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /,'00 1 Departure Time: �JV County Region: FW
Farm Name: /I,en /" r-4 Owner Email:
Owner Name:/ Lin Phone:
Mailing Address:
Physical Address: r�
Facility Contact: IS l� ��✓t� Title:
Onsite Representative:
Certified Operator: �11-
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = 0 Longitude: =1 o =1 = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
[❑ Wean to Finish j I
Wean to Feeder kaVbo
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
... 7w
Cattle Capacity Populatiol
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
4,
{
Number ofStructures:
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 &o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
AjNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
54 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
CKNo ❑ 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 ElNA ElNE
(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
§a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t9 No
❑ NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: Y% 0rzM_171-_5ca
Reviewer/Inspector Signature: Date: //t20 man —7
12129104 Continued

e
Facility Number: Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5kNo ❑ 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�SNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ctil 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
DqNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Da 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
N1 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
0 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit &Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: , - Departure'rime: County: Region: ��
Farm name: r / Fetr,-,-- Owner Email:
Owner Name: m r - Rdm 'e `-L- Phone:
Mailing Address:
Physical Address: /
Facilitv Contact: Z22=&/`t'//�✓Title:
Onsite Representative: A�-ZL 'q.
Certified Operator:, D-C 24-e✓ti
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = u ❑' ❑ " Longitude: 0 0 E = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1 O a ❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
YeO
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
r
Dry Poultry
❑
Layers
ElNon-Layers
❑
Pullets
❑
Turkeys
❑
Turke Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifer
ElD
Cow
El
Non-Dairy
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Co
Number of Structures: ©`
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P§-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12128104 Continued

Facility Number: '!?- -/7 1
Date of Inspection 61
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
I,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): �] / 9
Observed Freeboard (in): 3,C 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
®,No ❑ NA. ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
(R 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
f@ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5� 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
RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
D[ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN 7 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) Li7'a��c y4tC5z-rd
13. Soil type(s) Z=lx / 4 � .a--
V
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
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination! ❑ Yes
(&No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
o
Reviewer/ins ector Name
-!/. ���� Phone:
P O'3- ao
Reviewer/Inspector Signature: Date: 1r,2 — /yam a-,;Z&D(o
12128104 Continued

J
Facility Number: Date of Inspection - �o
Re[tuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes nl No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Cj� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. fRYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield gL120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EZ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
K]�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office ofemergency 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
ELNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or; Drawings:`
i
•
Page 3 of 3 12128104

❑ Wean to Finish
❑ La er
���
®.Wean to Feeder
� Q
%�( �
❑Non -La el
t Division of Water Quality
riiity Ntifmber f O Division of Soil and Water Conservation
Q Other Agency
Type of Visit i5 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit AO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t~ ; D Arrival Time:
10 Y� Departure Time: � County: zU Fled Region:
Farm Name: AlLew --grin 7 +1 � Fame _ Owner Email:
Owner Name: 40 �%A[A Aff evt_ Phone:
Mailing Address: 65-9 3 re�4 _ tZe ad- _ _ _ l��a��.c� t 1J L 2-16 S W
Physical Address:
Facility Contact: [ Title:
��ll
Onsite Representative: l:-ai/ LQ!20.A
Certified Operator: C'_0 U 'Q'�
Back-up Operator:
Phone fNo:
Integrator: _ �; �s�f-f�a. o _
Operator Certification Number: _ Ito Z-6.9
Back-up Certification Number:
Location of Farm: Latitude: 0 e = i = Longitude: 0 ° =1 = "
Design �-' a rent Design Cuireiit Design Current
Swine Capacity 1?� p 1� anon, Wet Poultry Capacity j Population Cattle Capacity Population
❑ Dai Cow
❑ Dai Calf
❑ Feeder to Finish ',s >; A' ❑ DairyHeifer
_ 9r�
❑ Farrow to Wean Dry Poultry rr ' ❑ D Cow
i
❑ Farrow to Feeder ❑ Nan-Dai
❑ Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑ Beef Feeder
❑ Boars ❑ Beef Brood Col i
� v
❑ Other Number of Structures:
❑ La Ts
-Layers ers
❑ Pullets
❑ Turke s
❑ Turkey l'oults
❑ 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)
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 RLNo ❑ NA ❑ NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
®NA
[I NE
❑ Yes
❑ No
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
]&No
❑ NA
❑ NE
I2/28104 Continued

Facility Number: 4:1 ! � Date of Inspection Zla
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: : /` --s- -
Spillway?: h o 69
Designed Freeboard (in): m '12
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No RNA ❑ NE
Structure 5 Structure 6
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes RNo ❑ 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 [9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9No ❑ 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 Amfication
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 A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) &;
13.
Soil type(s) LJc F
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
Q3 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
.... . a_-.. _-y:-r..':::ai�3'ix`S:3sPkAR.'�LL1a,_S.wrar=a"I..r_.::;P'-.
IReviewer/]nspector Name '-� ":K Phone:
Reviewer/Inspector Signature: Date: f 0/Z-�'�c7S
12129104 Continued

Facility Number: Date of Inspection 0 Z(c 0
r�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ 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. ❑ *6p ❑ Checkll is `� ❑ Design El Maps" El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ No ❑ NA ❑ NE
Waste ApplicatioV ❑ Weekly FreeboaM"' [X Waste AnalysiAl❑ Soil Analyse ❑ Waste Transfers ❑ Annual Certificatior✓
❑ RainfaIV0 Stocking;/❑ Crop Yield' ❑ 120 Minute Inspectiont" ❑ Monthly and I" Rain Inspectiont/ ❑ Weather Code/
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
[:No
❑ NA
❑ NE
❑ Yes
QNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
ESNo
❑ NA
❑ NE
❑ Yes
J�j No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[]Yes ESNo ❑ NA ❑ NE
❑Yes 8No ❑NA ❑NE
❑ Yes RX No ❑ NA ❑ NE
7,5 . Nee4 41D FkL"` Of aC:{�c3+1
•sft-
Z [ . Pl S v re -fr, PA-AJ - ,P `tom lee - Z qrclr� S
Zt. &_ - rc� wu s a..� Lc j S, S a,- ec� eL eY sty as l{a
GerU'et- C4-41're— c1 P1° �� c sz c i �'� ri c�trW S C l— 4r i
��: ; v� art 1
12✓28104

Type of Visit 0 Compliance Inspection O Opemtion Review O Lagoon Evaluation
Reason for Visit 48 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visits // O /o Tune:
., 10 Not rational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
FarmName: 44 I l -c u N -- r = _,,,, , , County:. _• a n nPery �� ..,� u
Owner Name • _ �r Phone No: 4 o G �f S Sr
Mading address:
Facility Contact:
Title:
OnsiteRepresentative: _1• • _••
Certified Operator: n r- -
Location of Farm:
. _. Phone No: ,
Integrator: _ _. rc .s I a g
Operator Certification Number: A /G a e—
[] Swine ❑ pouttry ❑ Cattle ❑ Horse Ladtade • Du Longitude •
Discba es 8 Stream "ccfs
1. Is any discharge observed from any part of the operation?
❑ Yes [A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance znan-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin? Ill / A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [P No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: '`�
Freeboard (inches): 7 / 29
12112103 Continued

T .
Facility Number: % — 7 Date of Inspection !J o9 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ['3 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes M No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancehmprovement? ❑ Yes ® No
B. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes No
elevation markings?
Waste Anvlieation
10. Are there any buffers that need maintenancefumprovement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes E3 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type s e u �u- c3 ► Z el� a ff �,+ rct .t: S M ; Ile 4-
F•
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J No
b) Does the facility need a wettable acre determination? ❑ Yes 12 No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [N No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JRJ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes j No
Air Quality representative immediately.

Facility Number: — / 7 Date of Inspection iJ a g/f
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
X No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
{ie! WIT, checklists, design, maps, etc.}
Yes
No
23. Does record keeping need 'improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Impector fail to discuss review/mspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
El Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
NPDF,S Permitted Facilities
34. Is the facility covered cinder a NPDFS Permit? (If no, skip questions 31-35)
® Yes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
53 No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
© No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 124 Minute Inspections ❑ Annual Certification Form
12172103

of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine - O Complaint O Fallow up O Emergency Notification ®Other ❑ Denied Access
Facility Number 49 17 Date of Visit: 3/18/2004 'rime: l:OOpro
Not O erational 0 Below Threshold
®.Permitted ® Certified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: -...-.......
Farm Name: t ext.&FOLIlg.I:Se.Fairin...............................................................
Owner Name: B-Q0.ald.................................... Allea..--.----..-.......-.............-.
County: 0l<asicl0................................................ kiiQ••-••...•....
Phone No: 9104.48.4.525 .................
Mailing Address: 65..9.3.Gcmte,x-.ttaad............................................................................... > ladeubnKn..NC..................-......-.....-.•..-.......-...... M320.............
Facility' Contact: ......................................... .......... .....I•itle: ... Phone No:
Onsite Representative:........ .......... ...... ........... ...................... ................... Integrator: ��e�1A�e.Fa[r7�S.............................
Certified Operator:,lAg........................................... Mimi Operator Certification Number: .lfe26B.............................
Location of Farm:
From Elizabethtown take hwy. 41 W. 9 miles take left on 131S. go 1 mile take a right on SR 1100 go 3.6 miles farm is on the
eft.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 36 00 w Longitude 78 • 48 34
Design _-Cur ient
Design.:
Current
Design ;Correll#
Swine
- :
i Cattle
Capacity, 'Po niation
® Wean to Feeder
12160
JE1 Laver
❑ Dairy
❑ Feeder to Finish
JE1 Non -Layer
I
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
12,160
❑ Gilts
Total SSLW
364,800
❑ Boars
Number of Lagoons' 2
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (Ifyes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, whatis the estimated flow in gal?min?
d. Does discharge bypass a lagoon system`? (Ifyes, notify DWQ) [I Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
NVaste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure i Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
1211210-3 Cnnlinued

Facility Number: 09-17 Date of Inspection 3/18/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or (] Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
[]Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of Iagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
[DWQ
to,*iiition #) Explain any YES answersand/or any recommendations or_ any other'comtnents A,�i ise dra-Mngs of facility to better explain situations. (use additionalpages as necessary}: ® Field Copy ❑ Final Notes staff drove by and observed an irrigation event taking place- Everything we could see from the highway looked to be in
Reviewer/ins ector Name "
p Larry Baxley MarLBrantety
Reviewer/Inspector Signature: Date:

r 1
Drvtsron-of V4°ateC Qnallt}'
3 a
Divtslon of Sail andWater Conservadion
i r4 n t �. = - &t - c,rr : f. ,d+ r�r `� 3Y V?' "� +" d ``� r rh ¢ n •r `;�.•� �,
�-
+?�
i T,,-. _. ..�-�.vs.. <.... - .r_ -. �t. k. .�.-��. _. _ b,.. ;,.�w r, ,.Ci,. ,.arc, ..�.-,.t�. ..z. - _-..t.ti,f .,--.� ��x5.� ... o.. ."5�, ` �' �..�'L b-. .scrhj �.t��n -. • .
Type of Visit O Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine Q Complaint Q Follow up Q Emergency Notification ® Other ❑ Denied Access
Date of Visit: 3/18/2004 Time: 1:tlOpm
Faci6h' Number 09 17
Q Not O erational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ................. -.. .
Farm Name: A llcift.01r.01buxEAlunt........................... County: Bladell ............................................... ERO ............
OwnerName: Ronald ------------------------------------ Allen. ........... ................................................. Phone No: 910•64M52S...............--.--...................-----.----.-------.
Mailing Address: fi59. entt��.Road .............................. ... Bladenboro ..NC ....................... ........................... 2.8320 .............
FacilityContact: ..............................................................................Title:-------------------- -- - -- Phone No: -------------..
Onsite Representative: .... Integrator: l'resjWg6Farws.....................................................
Certified Operator: jo.e........................................... Men .................................................. Operator Certification Number: 162,62 .............................
Location of Farm:
From Elizabethtown take hwy. 41 W. 9 miles take left on 131S. go 1 mile take a right on SR 1100 go 3.6 miles farm is on the +
eft.
® Swine ❑ Poultry ❑ Cattle ❑ Horse latitude 34 • 36 00 u Longitude 7S • 48 L 30 u
Design Current Design Cti'rrent Design,' Current
,Swine--. Ca aci Po elation Poultry Ca achy Pa elation Cattle_; capacity. Population
® Wean to Feeder
12160
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Laver ❑ Dairy
❑ Non -Layer ❑ Non-Dairy
,log er
Total Design Capacity 12,160
Total SSLW 364,$00
Number of Lagoons 2
Hnldinv Pnnda/ Cnlid Trans
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ar ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Identifier:
Freeboard (inches):
12/12/0.3 —
................................................. ...................................
Continued

Facility Number: 09— l7 Date of Inspection 3/18/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11, Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
1 se.r -:.-9' - :. -. '.r [ Comments;(r'efer to'ialieshoa,#) Explain >d- - ��" 'Y�' ,. �; .,: ,: r •,: - � y � ,: , n+rY e. m( meuts an.y YES answeis audlor anyrecommendaonoth
�.
Use draAngs of facility to better explain s Eaahons: (use "ditional pages as necessary):, ®Field Copy ❑ Final Notes
77 .:4£..
WQ staff drove by and observed an irrigation event taking place. Everything we could see from the highway looked to be in L
Reviewer/Inspector Dame LarryBaxley Mark Brantely
Reviewer/Inspector Signature: Date:

Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ' Z) Departure Time: ; � I� County: Region:
Farm Name: Owner Email:
Owner Name a Phone:
Mailing Address:
Physical Address: ,{
Facility Contact: r ;� 1 C''L a-U 1 T I v—n Title:.. Yt Phone No:
Onsite Representative: Ste— Integrator: 26
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E:] e =]' = v Longitude: [= ° [= 4
Design
Swine apacity
C
Current Design Curren t Design C•nrrent
PopulaontiWet Poulhy Capacity Population Cattle Capacity Population
10 Layer I ❑ Dairy Cow
❑ Non -Layer El Dairy Calf
❑ Wean to Finish
® Wean to Feeder
O
El Feeder to Finish
❑ Farrow to Wean
❑ Dairy Heifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -La ers
❑ Pullets El Beef Feeder
L Turkeys El Beef Brood Co
❑
❑ Turkey Poults
❑Other 1Vumber of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'ther
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PkNo
❑ 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?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stnicture 2 Stricture 3 Structure 4 Structure ; Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): _ j / p?cr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
CKNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the perm it?
El 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
51 No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E No ❑ NA ❑ NE
maintenance/impmvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
FglNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind ElApplication Outside of Area
Drift
12. Croptype(s) ly], p
j(.- /`ia4eyL_ /SL�s-
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LKNo
❑ 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
S�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
59-No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
oo pt �Oc_ jJee) '-rD— Otp cL FDA` fbr
Reviewer/inspector Name Phone: % p /(ja3' -530
Reviewer/inspector Signature: Date: dor

Facility Number: Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C,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 ❑ Desig
n ❑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" stain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z 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
ER 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
R,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2,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
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Eallo
❑ NA
❑ NE
12128104