090023_INSPECTIONS_20171231

0/Z"Ilo
gar-r-u---,tyL�
Type of Visit (D<-ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: , DO Departure Time: County: Region:
Farm Name: o /t`L� tc�.SSC.cr� +�� Owner Email:
Owner Name: t`wbes�T �eSS Phone:
Mailing Address:
Physical Address:
Facility Contact: '4 _ _ r' Title: IRIJ • S,04L Phone No:
Onsite Representative: 1 r Integrator:
Certified Operator: �� b�� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 =' = Longitude: = o 0 t
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
==
❑ Layer
❑Dai Cow
❑ an to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish 1157
01
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
La
rsFarrow
e FO
Non -La ers
❑ Non -Dairy
Beef Stocker
❑ Beef Feeder
to Finish
Gilts
❑ Boars
Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑Turke Points
❑ Other
Number of Structures:
❑ 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?
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 0'1�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[,A
❑ NE
❑ Yes
❑ NN'o
Q NA
❑ NE
El Yes
(! No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Date of Inspection d
Facility Number: — a�7
Waste Collection & Treatment
,�/�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L�J No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ETNo
❑ NA ❑ NE
tructure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: I jc7
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,_,_
11 K.
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2<o
❑ 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
[�Ko
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
F io
❑ 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
[I Yes
�,
LKD
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ej<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/ Window l Evidence of Wind Drift ❑ Application Outside of Area
r
12. Crop type(s) �Of yrlyc�L l _ 9�1Clca�C� sl. C7-'Q,
13. Soil type(s) /Jp ,4
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
iR'N
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
l o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El,PYes
NNoo
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
Ell Yes
,�_,"
l<.
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
h
ETNo
❑ NA
❑ NE
Comments {refer to _ ues n4) Ex lain an YES -answers and/or an recommendations organ other comui }:
Use drawings,offacility to better explain situations. {use adds- al a es as necessa o , M
Reviewer/ins ector Name "*
P "' Phone:
Reviewer/inspector Si pre: / `.j,Al Date:
%�gi����f►S
Page 2 of 3

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,�, �Io^ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes [y o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. ElEJ,Yes No_ --r ❑ 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 ❑ Wcather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ll-lqo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t6J"Vo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
o❑
NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,M-
9<0"
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L1 Flo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ffNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
<o
❑ 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
}dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
-❑ Yes
2 o ❑ NA
❑ NE
Page 3 of 3 12128104

Rype of visit: U �commpliance inspection V operation Review V Structure Evaluation V Technical Assistance
eason for Visit: k! Routine Q Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: li r i Arrival Time: I 2q.,P IDeparture Time: County: .��*� Region:�
Farm Name: _ .� S�s�--4.rw� Owner Email:
Owner Name: jr= (-- Lc4_ 1 je-• o. Phone:
Mailing Address:
Physical Address:
Facility Contact: K U cg ol_k' /'1 Title: Phone:
Ousite Representative: Integrator:
Certified Operator:Certification Number: C Z
V
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
�, Current
Design
Cnreent
fsign Current
Swine
Capactyl
,Pop:
�:.
Pault
Wet ry
Eapa�city
Pap. €
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
.S od%p
t Ys
Dairy Heifer
Farrow to Wean
41
Design
Clirreef'
Dry Cow
Farrow to Feeder
D , li'oul
Layers
Ca aci
�a ..
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
!Turkey Poults
10ther
4
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[d'l ate❑
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
ETNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
[a'lq—A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[—]No
0-?qA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[1 o
❑ NA
❑ NE
Y. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fj'Ro
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Z- Date of Inspection: L C9G
Waste Collection & Treatment
4" Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-N-o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[2-NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑'1`l0
❑ 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
EE~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
E4-ND
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0-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 Q_hLo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3--No — ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G13
13. Soil Type(s): _ &
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D'I`]o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D-I ]G
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea<
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L] 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
WNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: Date of Inspection' OG
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3'1Qo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EKO
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 ©'No ❑ NA ❑ NE
❑ Yes ffN , ❑ NA ❑ NE
❑ Yes [Z.1'do ❑ NA ❑ NE
❑ Yes D_ o ❑ NA ❑ NE
❑ Yes
[ rKo
❑ Yes
❑-No
❑ Yes
El No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Gammeuts (referpgtipn #ij: Explain any ��Eanswers;aoii/aoyaddt�onal reeommendations or aayKother1comnsents. s
s,
Usei�rawingslof faiH toibetter explain situations;{use*additional4pa9cs�a necessary).`' k ifs "`tl s' K 5 ' ` ,.9,J t 7
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
tor
t l U Phone.jp — W33K
e: t tZJ16&W Date:
21412015

1 R'5 M NUV t, NJ
ivi"sion of Water Resources
Facility Number �L���
Division of Soil and Water Conservation
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: o V Arrival Time: / eb Departure Time: County: Region: F
r
Farm Name: t'�sc •%" Owner Email:
Owner Name: {"I N 3 ��'-GC,�[i Phone:
Mailing Address:
Physical Address:
Facility Contact: [ `'Cw[, �/1 Title: Phone:
Onsite Representative: Integrator: I`FJ
Certified Operator: ��r't �✓`"g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current ` Design Current
Swine Capacity P.
Wet Poultry
Capacity
Pop mottle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish SY qfjv
Dairy Heifer
Farrow to Wean
Design
Current Dry Cow
Farrow to Feeder
D . IP,oult
Ca acit
Pjo Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
t,._.
Other
Other
Turkey Poults
Otherk
f�U.,
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[�
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[]-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[•] No
❑ 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
0 No
❑<
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
E2 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes jf� No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faciti umber. - Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EnIN.
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�IA
❑ 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
[�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E�' o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
19-<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3'7qo-
❑ 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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ Ko ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 16 n-'- c 's 6 C)
13. Soil Type(s)
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E� 110
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
lid4o
❑ 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?
❑ Yes
[�f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E5^No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Wo
❑ 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 Of No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �lo
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214,12015 Continued

FacW Number: - Z Date of inspection:A(CV IV
24,Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
UG'No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
l4'1"O
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[314o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[2' 4o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2TNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑'NTo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C '-io
❑ NA
❑ NE
_r__ .. F
Reviewer/Inspector Signature: Dater
Page 3 of 3 21412015

Sena--(s Ab
Type'of Visit: C7Compliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: (r outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: J,A 02 County: tr Region: ! j�
Farm Name: V�,S 5�,� Sw19-' ��"�� � Owner Email:
Owner Name: t-we -4 r Sf'rta0 r^•- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 1 Integrator: PV-.-3 41 B
Certified Operator: S __� Certification Number: _ct2#s t z
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swiue
Design Current
Capacity Pop.
Wet Poultry
I ILayer
Non -La er
Design
Capacity
F
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Finish
Wean to Feeder
Feeder to Finish
Dry P,oul
ILayers
E.a aci
P,o
Dairy Heifer
Farrow to Wean
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
s
Turkey Poults
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�-N�o NA ❑ NE
❑ Yes ❑ No E3-�;R ❑ NE
❑ Yes [:]No Ej_KA ❑ NE
❑ Yes
❑ No
�A
❑ NE
[] Yes
Q No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�i ❑ 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
[]-11
❑ 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
❑1To
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Er o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-N--o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [31557 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes `� - - ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1211Qo [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ey No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E o'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[/r 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 ❑'I 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 Q No ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['1No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: q.- Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes yVN
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 13<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EE�<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
El"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[B'<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EN'N_ o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D i4o
❑ NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E jKNo
❑ NA
❑ NE
Reviewer/Inspector Signature: fitJ Date: 10 —5
Page 3 of 3 21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ►W jp j" /fJ Departure Time: County: ty Region-
Farm Name: ez t,.n�. f ` Owner Email:
Owner Name: b ex,,,, G#Aig Phone:
Mailing Address:
Physical Address:
Facility Contact: t4 el` —Title: Phone:
Onsite Representative: 1 t Integrator: , / -4
Certified Operator: fu�k
Certification Number: /?q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design •urrent
Swine Capacity Pop.
Wet Poaltry
Capacity
Pop.
@aide Capacity Pop.
Wean to Finish
Layer
aja Cow
Wean to Feeder
Non -Layer
D2ig Calf
Feeder to Finish
at Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D P,oul
Ca aci
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
_Turkey Poults
Other
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
D;W6— ❑ 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
ED-N-A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
Q-KA'
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
❑110
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [/yNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of In ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
[ 1 u
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No__gD-N7C_
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E;J-Ro
❑ 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
2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2No
❑ 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
[?To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[211lo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 < ❑ 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 Outsides of Approved Area
12. Crop Type(s): CR ad j , 10G4-%f_ ! AJq (j 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qi `Po ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [EINo ❑ 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 [!No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWW 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 dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes � o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 4No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of inspection- jAf
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [:]No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer,to question.#) Explain .any YES answers :and/or any additional recommendations ar any other comments'Af77
Use drawings of facility to better_explaia situations:, {use additional pages.as necessary):
G41. b4 / jLn — 9-1I-13
Sl�jk 9ca,-v&7 6-1Y-73�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
5,a
Phone: qn- 3 3
Date: 16:�;&
21412014

Type of visit: L,?-Uompliance inspection U Vperation Keview U,tructure Evaluation U 1 ecnnical Assistance
Reason for Visit: Q outine O Complaint Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: rrival Time: Departure Time: L County Region
Farm Name: g-��G« C �I.t„/1 ) iye-y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �,, y(� &/tir, Title: Phone:
Onsite Representative: IJ Integrator:
Certified Operator: 4.4Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design C►urgent
Swine
Capacity Pop. _ `_ _
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
-
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
j'
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D ,I Poult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
- -
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 pan 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 Gn4o ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
M A
2iA
❑ NE
❑ NE
❑ Yes ❑ No E!!rNA ❑ NE
❑ Yes 095o ❑ NA ❑ NE
❑ Yes Cff No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Cy- Date of Ins ectio 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in):^:_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 161 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 [ja o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[EkNo
❑ 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
UKo
❑ 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
To
❑ 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): -tJWk tc.dn, .5
13. Soil Type(s): _ 6)OA[,/1 tf
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ejl�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
BNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [3No
❑ Yes 2*No
❑ Yes �o
❑ Yes E_Z o
❑ Other.
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [? o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 53No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

w a
Facility Number: CM
- 4 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q.N6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Q15ro ❑ 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 ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes C5<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [,io ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®0Iio ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes [r �Kb_ ❑ NA ❑ NE
❑ Yes
0_1N0
❑ Yes
M.-No
[—]Yes
�o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments_:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone D` `�6_'_36�
Date: ab 5�t� 3
21412011

F r
I
Facility Number © ® Division of Soil and monservationJi—
'
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason. for Visit: uutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y l rrival Time: p Departure Time: D County: Region:
Farm Name �, ��fi Z-54 u� -Z r rr` 1 Owner Email:
Owner Name: a.,,. Ci + LTA "`� - Phone:
Mailing Address:
Physical Address:
Facility Contact: \ Title: Phone:
ij�
Onsite Representative: Integrator: r`jl
Certified Operator: t SP .,4. ice- ra`r Certification Number: �} t.E�y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop: Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I
11
I Layer
Dairy Cow
Wean to Feeder
INon-Layer
I
Dai Calf
eeder to Finish
/
Design Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P.oul Ca aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [jjNo [DNA [] 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes EC No
❑ Yes F�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: E7 - Date of Inspection: 13
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 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ej 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
6No
❑ 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
M No
❑ NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fj� 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
J;�_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L3-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): &.,-/10( rsz
13. Soil Type(s): p .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes Dg.No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
25 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes DNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

. Facility Number: ft - Date of Inspection: -- 3-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA ❑ NE
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
MNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
JZ 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 CA WMP?
33. Did the Reviewerfinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ud_No ❑ NA ❑ NE
❑ Yes r�--1 No ❑ NA ❑ NE
[—]Yes [RNo ❑ NA ❑ NE
0 Yes !! No ❑ NA ❑ NE
❑ Yes
KNo
[:]Yes
RNo
❑ Yes
� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) ExPlatn any;YES ansl dlor an3 adiithonal;recommendaHuns ar:`any ottiercomments.
Use drawings of facility to'better ex Lam sitodtions. (use additional`;` a es as necessa t�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
Z v
21412011

'�- M. a
Type of Visit Q,"Comp lance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival
-Time. �,'7 C Departure Time: County: Region:
Farm Name: O rn'L 1 Owner Email: _.
Owner Name i5 �7 ®h H. O Phone:
Mailing Address:
Physical Address:
Facility Contact:
0�'Title:
Onsite Representative:-��"�•t— j
Certified Operator: Sa41 -
Back-up Operator:
` 9epel, Phone No:
Integrator:
Operator Certification Number: 17 -1
Back-up Certification Number:
Location of Farm: Latitude: ='
=' = Longitude: = ° = 4 = «
Design
Current Design CurrD ent '" esign Current
Swine Capacity
Population WetPonitry Capacity Population_ Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
Feeder to Finish
Dryoultry.
El Dairy Heifer
EIDIX Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
Other"
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
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
J.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
DNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

P
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IgNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
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
91 Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CRNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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)-
13. Soil type(s) Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes El No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes ®.No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes S-No ❑ NA ❑ NE
77u tA� ✓`8-e
Reviewer/Inspector Name _�.__ Phone: >D
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: - Date of inspection /� 1
L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PLNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes JRNo ❑ 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 Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
I Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
N(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
29 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q,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
i9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional,Commenis and/i1r Drawings:
y �
Page 3 of 3 12128104

ivision of Water Quality
E
cility Number Q O Division of Soil and Water Conservation
_._... - _.._... 0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q rtoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i'Q9-(}9 Arrival Time: .2'SCJ Departure Time: . 3� County: 8l �P'.i Region: F120
Farm Name: RobEy4 -�yc55up Aaiyo.• Owner Email:
Owner Name: �a%e r T TGSS Phone:
Mailing Address:
Physical Address:
Facility Contact: — 1iCGt +t.� w-jC[.Y' _Title: Fi �C- • S� rt . Phone No:
Onsite Representative: Integrator: r res-Aa i - V44
Certified Operator:°b Operator Certification Number: 9 4 2
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 1--] o [--] 1 ="
Longitude: = o = I = K
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 5i fiS—
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet,Poaltry Capacity Population
❑ Lay er
❑ Non —Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current '
Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ 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 Ergo ❑ NA ❑ NE
❑ Yes ❑ No Is NA
❑ NE
❑ Yes ❑ No . ❑<A
❑ NE
ElYes ❑ No NA
El NE
❑ Yes Bl�oo 0 NA
❑ NE
ElYes L?No ❑ NA
❑ NE
12128104 Continued

Facility Number: a�J'- 23
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure t Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 259
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 , N"o ❑ NA ❑ NE
❑ Yes L`_fNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes Lg'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ErNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes BNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No ❑ NA ❑ NE
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑'1 I� ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
n l
12. Crop type(s) _pGhM�cL�- -�Nv 7 - ra C ✓ Ana i �►v �.J ��. 5 .
13. Soil type(s) NO
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
I S. Is there a lack of properly operating waste application equipment? ❑ Yes
[TNo
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
��No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 2 t�G\/ CJs Phone: 9f0. #33. 33341
Reviewer/Inspector Signature: A A—IC4-1 Date: 7- O 9 - 2D0G1
I2/1S/Y4 Continued

r- Ii
Facility Number: O q - 23 Date of Inspection 7-09-D
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [_Z�96 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E o
❑ 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
L�#'No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
Milo'
❑ 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
2 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
GWo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�,�
o
❑ 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
NNoo
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
3<0
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit (3Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' Arrival Time: /: 04 ,. Departure Time: 3 OQ County: 9hwrl-/ Region: F220
Farm Name: Rinbe4 /::At r7ft % Owner Email:
Owner Name: )Q)Letr .I Phone:
Mailing Address:
Physical Address: '/
Facility Contact: A/s,7 u �u qan/ Title: �t � . ��C � Phone No:
Onsite Representative: /t a U bari, A/ Integrator:
Certified Operator: &&x�f A 3" Operator Certification Number: � � 9 z L
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =I =1 11 Longitude: =° ❑, Q "
egn Current
IIID—S,'
pcity Population
❑ Wean to Finish
❑ can to Feeder
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Design urrentlillill
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
pry Poultry
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Finish
Gilts
❑ Layers
❑ Beef Stocker
Non -La ers❑
Beef Feeder
Pullets
PE113oars
❑ Turkeys
Other ❑ Turkey Poults
❑ Beef Brood Cow
Number•of Structures:
❑ Other ❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EINo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
4No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
�kNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ YeS
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

v
Facility Number:
Date of Inspection W__6TO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes VNo
❑ Yes 0 No
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): &�o
flaC-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rW No 8NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed ❑ Yes [O No &NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [$No tNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes No j$NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 9-4
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo WNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 2rNo N7A ❑ NE
mai ntenancetimprovement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes Pff No KjNA ❑ 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) ���.,dw (14- �3 G v� t_)
KO. S .
13.
Soil type(s) Alo 4 Ivo3
t4.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1$ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
qNo
❑ NA
❑ NE
16.
Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[A No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
t ' p
?'
Comments (refer to..question #): Explain any YES answers and/or anv recommendations or an` other comments
$. w was. 3'
Use drawings of facility to better explain situations. (use additional pages as necessary):;
Reviewer/Inspector Name ��y� S Phone: Si33, 333 0
Reviewer/[nspector Signature: Date: $1-47y—ZOD S
Page 2 of 3 12128104 Continued

.
Facility Number: o — z 3 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'! ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,YNo ❑ 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
[7f No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
q No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[,INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
05No
❑ 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
[No
❑ NA
❑ NE
andlor Drawings:
Additional Comments ".
Page 3 of 3 12128104
Page 3 of 3 12128104

,EAIAC_Wd 6� RIz 7-Z4i-7-061
S Division of Water Quality
Facility Number Q 9 Z 3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ®rtornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %- /Z - p% Arrival Time: /O,' O Departure Time: Z County: Region: A20
Farm Name: Rv j,�:J� sSIi it �^s.-r / ��� Owner Email:
Owner Name: )eo beyf _ 3GSS�T Phone:
Mailing Address:
Physical Address:
Facilitv Contact: Je°la�vf T�Ss�eD Title: Phone No:
Onsite Representative:.SGw/uAlew BYbcc/,4&/_ Poggje Integrator: a
Certified Operator: 90 G c4, 3 `SS.4A _ Operator Certification Number:
If
Back-up Operator: Sjw_, / Alle ✓ &X44 Back-up Certification Number: 9'899�z
Location of Farm: Latitude: = e Longitude: ° u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
[� Feeder to Finish 15156
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current-
Capacity : Populatioan. s
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ 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 Q?No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[NNo
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: Date of Inspection
l Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IN No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes (B No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
El NA El 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
X No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EYNo
❑ 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
FNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�WNo
❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
UNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)--
/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
217No
❑ 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
RFNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J9No
❑ 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:
Reviewer/inspector Signature: Date: 7 —/Z —ZOO 7
12128104 Continued

r
Facility Number: A Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)( No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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
OB No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
cP No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
V9 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
V1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit (compliance Inspection O operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Da Departure Time: .� County:
Farm Name: m- Owner Email:
Owner Name:Glnee+ iC.S._5 U 22 Phone:
Mailing Address:
Region -
Physical Address:
Facility Contact: [C Title: Phone No:
Onsite Representative: Integrator: O.r:h r_
Certified Operator: ► v E' [ . -� - Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: 0 ° 0 j = "
Design Current
Swine Capacity Population
Wet Poultry
Design
Capacity
urrent
Current Own,
Population Cattle ulation
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Non -Layers
❑ Pullets
❑ Gilts
❑ Boars
❑ Turke s
Other.
❑ Other
Turkey Poults
Ether
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
K No
❑ NA
❑ NE
[:]Yes
(KNo
❑ NA
❑ NE
[:]Yes
9No
[]NA
❑ NE
❑ NA
❑ NE
[:]Yes
)&No
❑ Yes JK No
❑ Yes ® No
Page 1 of 3 12128104
❑ NA ❑ NE
❑ NA ❑ NE
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
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
,Q No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �?�2
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JEJ 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
DINo
❑ 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
X No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
.9 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
JK 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,9 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)TV`YYLUD[�„��(1Cr�sC��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 14 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? [:]Yes ZjNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes R No ❑ NA ❑ NE
i t �"st'-7' :a�rx tom:
Comments (refer to question t�: Explain ariy YES answer"s and/or any recommendatiflns�3o�rYan other�,comments
Cise drawings ol'facility to better explain situations: (use additional pages as necessary)*T r s �5
Reviewer/inspector Name Phone: C21AV6 �3.3aO
Reviewer/Inspector Signature: Date: p� 3C7
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J9 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 J,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 V[No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes IN No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes H No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes )4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
MNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CK No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit @ Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: q Arrival Time: Departure Time: County: 161 Region: ` AL
Farm Name: �X'}" �� uc, G.rhn Owner Email:
Owner Name: -Se-Ss. Up Phone:
Mailing Address: _ PO go.K 468 o L z d 3?7
Physical Address:
Facility Contact: Title:
Onsite Representative: nn" 4,►� e, cs...`
Certified Operator: KO "�e_-5S v,P
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No: Integrator: 'fin
r
�Z
Operator Certification Number: l r Z Z
Back-up Certification Number:
Latitude: E:1 0 = , = u Longitude: o = ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1' ❑ La er
_.�11❑Non-Layer 1 11
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurke Puults
❑ Other
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dr y Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
i`
Number of Structures:. ©k
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
%No
® NA
❑ NE
❑ Yes
WNo
® NA
❑ NE
ERNA
❑ NE
❑ Yes
❑ No
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Fqe+lity Number: — Z:: Date of Inspection _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: +r1D
Designed Freeboard (in): A.
.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QiVNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[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
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑\Application Outside of Area
vi\
12. Crop type(s) C7�r't� tAx .. U <g� rA p� (zqg J ,ilk q t`a; K (SD J
13. Soil type(s)
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
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes
[3 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
8 No
❑ NA ❑ NE
Ilse drawings ofif icditytolbetter e�p atn sttaatfons: tnse' addittonal pages as necessary}:
�" . %� O maw V�-- P � � � r-a+n� uv �� "�'� ► c T . t�a�. a-v� CJ u� S r +S � g �a u S i
d k-e w.� (� . ���a 32 - �l � ,� `�'t,e eirodJ
t .
Phone: Reviewerlinspector Name tom` "'
Reviewer/inspector Signature: Date: 4
1212VO4 Condnued

Facility Number: — 2J7 Date of Inspection �f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [gNo ❑ 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. ❑ WUPi ❑ Checklist9- ❑ Design X❑ Maps p < ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ® Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[--]Yes
JQ No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
[�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eallo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[)gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
El Yes
�(
6 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XtNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[Z No
❑ NA
❑ NE
Addiittiina]Commeots';aQd/oDratiyings_
Cr_ r C, jr! r-4-0
ZE. 7�-t�� vta+ i ►t� a �(, �,.q �o { �� *_ ` C��v�- -u (� �v-+
' 046 "o- --;
9 :S 0. crvc- te- a e.-di
ea a" -t-�a� i r --4-� � t rLe t w< wt eoh a � Ly 4-o ctvo - & 0.
12128104

July 28, 2005
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
RECEIPT # 7002 2410 0003 0274 6907
Robert Jessup
Robert Jessup Farm #1
PO Box 608
Elizabethtown, NC 28337
RE: Sludge Survey Testing Dates
Facility # 9-23
Bladen County
Dear Robert Jessup:
Michael F. Easley, Governor
WilliamG. Ross Jr., Secretary
North Carolina Dcpanment of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
The Division of Water Quality (DWQ) received your sludge survey information on
March 1, 2005. On your behalf, Kathy Dugan requested an extension of the sludge survey
requirement for the lagoon at Robert Jessup Farm #1. Due to the amount of treatment volume
available, DWQ agrees that a sludge survey is not needed until 2007. The results of the 2007
sludge survey are to be submitted with the Annual Certification Form that will be due on March
1, 2008.
Thank you for your attention to this matter. If you have any questions, please call me at
[phone].
Sincerely,
Keith Larick
Animal Feeding Operations Unit
cc: File# 9-23
Mark Brantley, Fayetteville Regional Office
Kathy Dugan
I
Carolina
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: httpWh2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
Fax [phone]
An Equal OpportunitylAffu nature Action Employer— 50% Recycled110% Post Consumer Paper

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
]Date
Nmmber of visit: �a /l3 I Time: I�
Facility �3
Q Not 2arational Q Below Threshold
13 Permitted 13 Certified 0 Conditionally Certified © Registered Date -Last Operated or Above Threshold:
Farm Name: M County: Ql--- -
trxa
Owner Name: Phone g `�� — 3 i ! S
o e No: _ ,,. _
?bfading Address: e • C7 _ a �l 6 O k .2 8 3 3 7
Facility ContRet: — Title:
/
Onsite Representative: ^'t r. r�.�n / /e-c t& ._ Qsr a c* ter_--_-
Certified Operator,.
..- �-6�rf L�' s
Location of Farm:
_. Phone No:
Integrator.
Operator Certification Number:
06 Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ` �46 Longitude • �K
Swine;
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
- la�tat Desjcnr ;a�ac,>Ety
Totwismw
Ntmser o#out<
Dischmes & Stream Impacts o
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 ocf the State? (If yes, dotify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? /VIA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there a"vidence of past discharge from any part of the operation? fl ❑ Yes No
o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ° ❑ Yes j No
Structure I Structure'2 Structure 3. Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
I2112103 Continued
0 e o

Facility Number: 9 — ,23 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion,
❑ Yes
(j 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 maintenancefunprovement?
J] 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
P No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen (wound ❑ Copper and/or Zinc
12. Crop type E r r- .,, � a. 4 W 1 C3 r o. s+ 5y.. 1 G r a.'i — o d e-r-CC 11V-
13. Do the receiving crops differ with those designated in the Certified Animal waste Management Plan (CARrMP)?
El 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
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15_ Does the receiving crop need improvement?
[I Yes
j] No
16. Is there a lack of adequate waste application equipment?
❑ Yes
W No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
❑ Yes
[!I 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
(U No
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
14 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
W No
Air Quality representative immediately.

FaciVty Number: —.23 Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application [Z Freeboard ❑ Waste Analysis j]Q Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(id discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7
NPDES Permitted FacHities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall a] inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ Yes 10 No
❑ Yes ® No
EN Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes (Z No
❑ Yes W No
❑ Yes Ej No
❑ Yes EP No
to Yes ❑ No
❑ Yes W No
❑ Yes P No
❑ Yes W No
❑ Yes 56 No
® Yes ❑ No
12112103

Q Division of Soil and Water Conservation [j Otlter Agency
4. f vim- e
Dtviston of Water Quality
�a"
�.c.,,;Y'��r+A';-�� ,• �1c-';"ri::x,n�§�'.<. �3",y: _...ka��._..._A.�,��,°$s..-..'. $ �,:;.,.� 9a:� '✓/`�` �..,�
Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection - -
Facility Number Time of Inspection 112,1yo 24 hr. (hh:mm)
0 Registered 0 Cerdfied © , Applied for Permit Permitted JE3 Not Operational Date Last Operated:..,,,,,,,,,
tz�
cL
x�....Farm Name:... 7Oe............................................................. County:..
Owner Name: .... G ........5_5
... .. ........ Phone No:(. .[..0.syy..:.�Qs1_5..........................
Facility Contact: .L.Lr.�....... �r ................ Title:....... Phone No: ...................................................
Mailing Address: .......vD.6.........&.GlLi..................................................................... ...��.2.oa-,bc.�Lr.. ..� ..
OnsiteRepresentative: ,-.L?/Arj&1�.....(,.��� Integrator: ----...I ...........
Certified Operator;...A.!�.. •. Operator Certification Number:...f j.?.-.ZZ........
Location of Farm:
Latitude Longitude 0• �' 0"
i a'`°:.Pouttry - '- ,
V❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
S"
❑Farrow to Finish
Fq
❑ Gilts
❑ Boars
Non -Laver I I 11'-J❑ N
�11 ❑ Other
�� _ Tn_taf;Design Capa
a�" otaLSS1
c
"c
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes No
2. 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?
b. If discharge is observed, did it reach Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ANo
❑ Yes
KNo
❑ Yes
gNo
❑ Yes
gNo
❑ Yes
KNo
Continued on back

Facility Number;O —Z3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures,(E;agaons,tioldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes E.No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft). ..................... .................................... ......... .......................... .................................... ...................... ............. ..................
..................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 9No
Waste Application
14. Is there physical evidence of over application? ❑ Yes KNo
(If in excess of WNW, or runoff enterin waters of the State, notify DWQ)
1? hype 1 /+
15. Crop �� �'.�:G_......�I!�LGL.�..1.....4�..rQ-t.►...-........ ................................ ..................... _...... ................. ....... _................
16. Do the receiving crops differ with ose designated in the Animal Waste Management Plan (AWNW)? ❑ Yes KNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes IJKLNo
18. Does the receiving crop need improvement? *Yes
19. Is there a lack of available waste application equipment? ❑ Yes l(No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
22. Does record keeping need improvement? ❑ Yes No
For Certified or Permitted Facilitit5 Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes *0
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes NNo
25. Were any additional problems noted which cause noncompliance of the Permit? Yes ❑ No
[]-No.violatiorts•or deficieitcies.were noted-ducitig this:visiL Yo't:Wvill reeei've.no.further-:
-;�corresporidehceab.outthis:visit:�:�::..: .-.�.-:�::..�. •: .�:.: ..�:�:•:•-.•.:.:-.•, .•
i2,
Neeai
4t3
wt.e,j " s [epe o � i c._ya, .
It
N eed
'0
warm e&­ &Jeeals `t r •✓erw.A.Z_4r j j qg h" JAri'to Iq_7
t eM
ZS.'
Al eed
4a
kee f c ! L-1 (a5ocm le,4.j rejj, . J
7/25/97

Fa cikr Nruaber: 0 9 - Z 3
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time:_ 1 I o O
GfflCrgI rnformatigrc
Farm Name: s, u p C,0WAr
Owner Name: Phone No: 0 10 59 V - /0 3
On Site Representative- intevmtw. pv t� Imo=•. r
MaWmg Address: 1>o &K (0 o ;
Physical Address&ocati4F --tom r.a 1 n +- -o N JL,4 er7
-�✓ Z ....; I �-� -� r .� r.Z � �- a .� 52 I7a � �_ � r � a 6�� '�...,1C...S
Latitude: / / Longitude:
.Operation Description: (based on design characteristics)
7jpe of Swine No. ofAnimals . 7jape of Poultry No. ofAnimals 7jpe of Cau4 No. of Animals �
O Sow O Layer O Daisy
ON y O Non -Lays D Beef
Mfvedcr - F:o _ SDI 1�5-
Other a of Livesmc - Number ofAnimalr.
Number of Lagoons: % (include in the Drawings and Observations the fraeboard of each Iagoop)
Facility e -
Lagoon .
Is lagoon(s) freeboard less than Ifoot + 25 year 24 hour storm storage?: CS -r-&)
Yes ❑
No a
Is seepage observed from the. lagooa?: -
Yes L]
No 0'
Is erosion observed?:
Yes U
No C$'
Is any discharge observed?
Yes O
No[)-'
O Man -marls a No: Mann -ma k
Cover Crop
Does the facility need more acrzage for spraying?:
Yes O
No Cj-,
Does the cover crop need improvemenL?:
Yes a
No 3'
List the amps which need hVr [j
Ckop�r .►�. _d ...
Setback Criteria ._ . _ .. _ - - . - --
..: .:.. • .
- . ..,
_
Is a dwelling looted wid& 200 feet of waste applic adm? �•�
Yes 0,
No a". - -
.:
- Is a well located within I00 feet of waste applicatim? - = -
Yes C.l
,No i -:
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes D
No 0-,
Is animal waste land applied or spray irrigated within 25 feet of BIue Line Stream?
Yes ❑
'
NOD'
AOI — Jauu =717,1 %

Maintenance
Does the facility maintenance need irnpmv t7 Yes D No W'
Is there evidence of past discharge from any part of the operation? Yes O NoCr'
Does record keeping need improvement? Yes 0 No C�
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No D"
• C4�- �. 6000 S 3 $
Explain any Yes answers-,
cc FaeiftyAssesvww Unh
Drawings ar Observations:
Date: Z -/- y —F C,
Use Anachmmu VNeeded
- ..-f:��+:-.._u..r r. � -.. �.a. - .-r � of r� arras..• �1+n� 7�++�s1•{t�s Nyi..f�••r,.,,.h.w.....��'+�r• -�+�.f
0 r.X- C. 3 � . ' r :�.,�i�.-�li�`:i �1'� i�+i'ti ��•��.1:• *i �'�t i�i i.���-'i:-4 iTr;� r "i.._ •_
....
y

Site Requires Immediate Attention: NO
Facility No. _ 0 9 — 2 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 -- / 9 , 1995
Time: // : 4L
5-
Farm Name/Owner: /5o b e, - t , c s s u .V- / / IS'o be_r t J e-ss!4
Mailing Address: AO i3 oX 609 ,E/; ; Q A 1 AQ "Al NG z 9337
County:
'Integrator: Przs twoZ-N G . Phone:
.On Site Representative: Phone: &/0) Sla Z — 3//5
Physical Address/Location:
Type of Operation: Swine PoultryCattle
Design Capacity: 5, / *5 Number of Animals on Site: 5 / 4i S
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I -Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No
Was any seepage observed from the fa oon(s)?
Is adequate land available for spra Yes or N
Crop(s) being utilized: s xC er#I&UU
Actual Freeboard: Ft. D Inches
Yes No Was any erosion observed? Yes o No
o Is the cover crop adequate? �or No
i
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes r No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes OR
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or©o If Yes, Please Explain.
Does the facility maintain adequate waste management reco ds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye. or o
Additional Comments: c s:/: fu We -it
fa%Neo
C dr i c_ S A lyo r e. Z / ` Z_0_�
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.