090056_INSPECTIONS_20171231

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit. 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Q Arrival Time: 'O yQ Departure Time: County: Q p,,, Region:
r
Farm Name: Z4'VEr �I� Owner Email:
Owner Name: ' 6;OVA AW"- Ko';V� Phone:
Mailing Address:
Physical Address:
Facility Contact:4-�.p� t✓�/
t!
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
�T
Certification Number:
Certification Number:
Longitude:
Dcsign Current
Design
Current
Design Current
Swine Capacity Pop.
1�Vet Poultry
Capacity
Pop.
Cattle Capacity Pop.
1€,
Wean to Finish
ILaver
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
�.
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
= D . P,oul
Ca aci
I?o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkevs
g Other
furke Poults
Other
JOther
. ._ _-yupsiiy.: ••••�-®
k.....::4+rh--.u:+RYc w....'�-s'.3:.!Lw4 i-
." �'.F`1:.._
Discharges and Stream ImDaCtS
I. Is any discharge observed from any part of the operation?
❑ Yes
jy,.�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
(] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Q - Date of Inspection: �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QjNo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes )QNo ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
r
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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?
l
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 0 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 Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �4S C'4s ) , �-' C-r"�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
1 T Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20_ Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, 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 1p No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: 10
24. Did thafacility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1� No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes W 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 0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 1� No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 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
other
Comments(refer to question #): Explain any YES answers and/or any additional'recommendations orany her comments.
Use d=iugs offacility, to better explain situations (use additional pages as necessary).
,
�P
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [ ` J?
Date: 1 ° 7/
21412015

Ii ype of visit: d comlinance inspection v operation xevtew U structure evaluation U Iecnnical Assistance
Reason for Visit: 6 Routine C) Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: D,`Pf1 Departure Time: County: &"4V Region: /E!720
Farm Name: +060._ Airm
Owner Email:
Owner Name: j j�, ��t►"t Phone:
Mailing Address:
Physical Address:
Facility Contact: V a4110_ LA.-4.7 Title: Phone:
Onsite Representative: Integrator: �S
Certified Opera ' • �'�
p qiM Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current.Design Current
Design Current
Swore Capacity PopetsPaultry ­Capacx�tyPop
Cattle Capacity Pop.
Wean to Finish
I ILayer I I I
Dairy Cow
Wean to Feeder
Non -La er I
Daia Calf
Feeder to Finish
"'
-
Dairy Heifer
ri v
. P,oulCa aci o .'
Farrow to Wean
I Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
ILayers I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
'
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 [allo ❑ NA ❑ NE
❑Yes [:]No �NA ❑NE
❑Yes ❑No �NA ❑NE
❑ Yes [:]No
❑ Yes No
❑ Yes No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Fgcili Npmber: - Date of Inspection: JQLZJW
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 6 No 'F NA
Structure 5 Structure 6
❑ NE
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q9 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [FNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑,Applica4on Outside o Approved Area
12. Crop Type(s):
13. Soil Type(s):
4 AI0-4 1.,4r A"iAh
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
1$_ 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.
U f
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
D NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes [P No
❑ Yes ® No
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P No
❑ Waste Application ❑ Weckly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: C1 jDate of Inspection:
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 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)
3 1. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes �q No ❑ NA ❑ NE
D Yes No ❑ NA ❑ NE
❑ Yes tp No ❑ NA ❑ NE
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 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: 3 300
Date: 1017WJ6
21412015

IType of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County Region:
Farm Name: O �-y�•4, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ` YJ +Pf 1_917ylt Title: Phone:
Onsite Representative: Integrator: v
t 453~
Certified Operator: {iy►itaM GVa44W1201Certification Number: 7 j
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet P,oultry_- +Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Fceder
Non -La er
Dairy Calf
Feeder to Finish
- _ ,; .
Dai Heifer
Farrow to Wean
-Design
Current
Dry Cow
Farrow to Feeder
Dr PoW x Ca aci
P,oP.
INon-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other R
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 P No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
[:]Yes
❑ No
❑ Yes
� No
[::]Yes
�g No
�NA ❑NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facili Number: - Date of Ins ecfioA:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Struc e l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard fin):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
P5 No ❑ NA ❑ NE
❑ No NA ❑ NE
Struc 6
❑ Yes � No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes F 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T 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 ❑ Applicatio Outside of Approved Area
12. Crop Type(s): �� /! �o7A' 4ta�?
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
tn/ No
❑ NA
❑ NE
❑ Yes]
No
[] NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis DWasteTrEsfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
21 Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili dumber: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [4 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Pg 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 [;E9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes in No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes t0 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
IP 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
09 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
29 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
EP 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 or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: rt{ !IS
2✓412014

Type of visit: a Compliance Inspection V Operation xeview U structure Evaluation V 'l ecnnical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: en Region: t-
Farm Name: p e r 1 (i ` m Owner Email:
Owner Name: �t�jer (" V'0t'Dr_'(S Phone:
Mailing Address:
Physical Address:
Facility Contact: ��(YlC�SM� Title: Phone:
Onsite Representative: �cucrc S 1�] Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
ertification Numbe :1
L
Cerh ica on Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry . Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
j!J
Feeder to Finish
Farrow to Wean
Farrow to Feeder
wurren
D . P,oul Ca aci P,a ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Non -La ers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[aNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FaciliNumber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard G7 "
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
® No
DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlleation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes B No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 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 Wind Drift ❑ Application Outside of Approved Area
fof
I
12. Crop Type(s): Cco S i {\6 (
AMU 2
l
qql
13. Soil Type(s): [All_,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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 [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes n No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9 No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes Vi 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 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 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
9 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
n No
❑ NA
❑ NE
tUo o Ic. _* 6J
Reviewer/Inspector Name: Kj kp�lvwko Phone: -7360
Reviewer/Inspector Signature: Date: L
Page 3 of 3 21412014

Itype of visit: w uompuance inspection V operation xeview V btructure uvaivation V tecnnical ASSlstance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z? I2 Arrival Time: 'DO Departure Time: D " .� a-. County:DFW Region:
�
Farm Name: —a48q �Q �TVI ti r" Owner Email:
Owner Name:t,�, [Cj�('� C"-m,%S Phone:
Mailing Address:
Physical Address:
Facility Contact: 1241 ld--- Title:
Onsite Representative:
� �1
Certified Operator: W i 1 Gt1'y�_ M
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator., T4
Certification Number:��
Certification Number:
Longitude:
„�,
Design Current 4,
esign
Current
= - Design Current
Swinetltry
iP
Capacity
Pop.
Cattle. Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
' ' ' `
DairyHeifer
Farrow to Wean'
°' w
Design
Current
Cow
Farrow to Feeder
Dr. P�oul
Ca ati
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OtherEN--
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes ❑ No
[:)Yes [:]No
0 NA ❑ NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: ---I jDate of Inspection:
Z__
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P_ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Ij
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33"
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�q No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tp 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 ,Chop Window El Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): c470s- A �fm" om";s (4-,
13. Soil Type(s): •70'TL4 r/YO
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
N No
❑ NA
❑ NE
[-]Yes
[0 No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes [5D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: Z Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 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.
PdApplication 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?
❑ Yes CP No ❑ NA ❑ NE
❑ Yes T
No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yestp No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
Reviewer/Inspector Name: 2D69A_M0,d2_1_f _ _ Phone: �Q% Yc3j�
Reviewer/inspector Signature:9ALA/M _ _ Date: Z7 L
Page 3 of 3 21412011

type of Visit: r Compliance inspection V Operation Review L) Structure Evaluation V I ecenical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1--—i r i Arrival Time: 12 ' Departure Time: OS,'go County:
Farm Name: -n� KI UQ.r it Mi Owner Email:
Owner Name: & weS Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: l45 6'10 Integrator: rr✓S +_
�.�- 9gof7
Certified Operator: W � �[ tQ r► Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
W I, Design, Current Design Current Design Current
Swine Capaetty� Pop _ Wet Poultry Capacity_ -, Cattfe Capacity Pap.
..Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
x.
Feeder to Finish
`"
DairyHeifer
Design Current
Farrow to Wean
Cow
Farrow to Feeder
D . l?oult . Ca aciPo - "'
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Cilts.
+
Non -La ers
Beef Feeder
Boars
Pullets
, • Beef Brood Cow
Turkeys
Other
,. ;_
.
Turkey Poults
Other,
Other
Discharges and Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structurc ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes fo No ❑ NA ❑ NE
❑ Yes
❑ No
[ANA
❑ NE
❑ Yes
❑ No
0 NA
[D NE
[] Yes ❑ No 2] NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes TM No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili " Number: - Date of Inspection: —70
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Ir
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FO No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ()j No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): 4
13. Soil Type(s): /" Al a A—,
fi✓,�� _
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑Yes
�No
❑NA
[]NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes �§ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �g No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of inspection:
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 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
❑ Yes
® No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
h
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ES 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
® No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
Yes
❑ NA
❑ NE
Ep Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r7,1 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
JK No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
✓t tk4� Q �'C ( �� �f
/'
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412011

s
Type of Visit 4P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 0 Q I Arrival Time: '• Departure Time: County: &_' /�' Region -.FA
Farm Name: 1 `Ve —z Owner Email:
Owner Name:JLC�J'E/ ��-�'DG��s Phone:
Mailing Address:
Physical Address:
Facility Contact: T94- Title: Phone No:
V
Onsite Representative: , l _ayvws _L[yKb _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Q o= I 0« Longitude: 0 0[= d
Design C►urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
® Feeder to Finish
Dry Poultry
❑ Dairy Heifer
El Dry Cow
El Non
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
-Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑Beef Feeder
El Pullets
❑ Turkeys
❑ Turkey Points
❑ Soars
Other,
❑ Beef Brood Cowl I
Number of Structures:U-1
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No P NA
❑ NE
❑ Yes ❑ No�INA
❑ NE
❑ Yes ❑ No [RNA
❑ NE
❑ Yes W No ❑ NA
❑ NE
❑ Yes 1PNo ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection f [
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
hNo?tnucture
[_]NA
❑ NE
a_ If es, is waste level into the structural freeboard?
Y
❑ Yes
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
6
Identifier: I
Spillway?:
Designed Freeboard (in):
rr��
Observed Freeboard (in): 07u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IP No
ElNA
❑ 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
[I NE
through a waste management or closure plan?
1
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
to No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Callo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
�kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[ 1 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
E�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):
AL
Reviewer/inspector Name Phone: 9 �-
ReviewertInspector Signature: Date: Loll 10
Page 2 of 3 1 12128104 Continued

• Facility Number: Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No [I NA [:3 NE
the appropriate box.
ElWUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P
No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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 P No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No � NA
El NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(� 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
[*bNo
❑ 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? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector 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
U No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

t
Type of Visit 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1/t/� I Arrival Time: 149fla, Departure Time: /O� County: BLM
Farm Name: S©i.& Z yr �iin Owner Email:
t7wnrr 1�`ama TY l P-4'6f'e Phnnr-
Mailing Address:
Physical Address:
Facility Contact: &"4.e__rxW4 Title:
Onsite Representative: ��5
Certified Operator:
Region:
Phone No:
IntegratorTr-e-269R —r-�
Operator Certification Number: ' `7%
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = ' = Longitude: = o u
Design
;Current
Design Current
Design Current
Svrine
Capacity
Pop anon
Wet Poultry Capacity Population
C•atile Capacity Population
El Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El DaiLy Calf
Feeder to Finish
/
❑ Daia Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
{ ❑Farrow to Finish
❑ Layers
El Beef Stocker
M"
i` ❑Gilts
ElElNon-Layers
Beef Feeder
'a, ❑ Boars
❑Pullets
El Beef Brood Go
k�
❑ Turkeys
Other
._
❑ Turke Points
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
r 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
11 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
T No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
toNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ONA ❑ NE
Stnreture I Stnrcture 2 Stnicture 3 Structure 4
Structure S
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
(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
T No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
(� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IF No ❑ NA ElNE
maintenance or improvement?
Waste duplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
��,//
L2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZNo ❑ 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 AcceptableCropApplication Outside of Area
Crop Window ❑Evidence of Wind Drift
f❑
nl.
CO(�wl "Ja CSS a'
12. Crop type(s) , Wt�4�zA^ aal
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ErNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
B No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
L'��No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
RrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1_KNo
❑ 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):
rr
Reviewer/Inspector Name Phone: ,3
ReAewer/Inspector Signature: Date: CY
121l'51W C.onnnuea

.F
• Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2<0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑Design [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 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
9,3"No
❑ NA
El NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,L�'J
RN' o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[;3"'No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
El"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
LI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional Comments and/or Drawings " g:
Page 3 of 3 12128104

Type of Visit • Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Q
Date of Visit: �$ Arrival Time- O: st�+�— Departure Time: /r County: 13LAD 1i Region:
Farm Name: S Rt Kr �^�,�, Owner Email:
Owner Name: �� �� 17"' Phone:
Mailing Address:
Physical Address: ,,
Facility Contact:%i Q-�'+xc4ouf Title:
Onsite Representative:leS 1a
Certified Operator:
Back-up Operator:
Phone No:
Integrator•e
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ` 0" Longitude: =o = t = "
Desgn Cu�rred"tom, Design Current Design Current
Swore *°Gap ty Popula, tion Wet Pogltry leac�ty�P�opulation Cattle Capacity Population
❑ Wean to Finish ❑ La er airy Cow
❑ Wean to Feeder ❑Non -La er airy Calf
Feeder to Finish �- �'* gym�� ❑ DairyHeifer
Farrow to Wean. ❑ D Cow
Dryoultry - .
. ❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers �^ El Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
❑ El Pullets
❑ Boars
,_ .. Turkeys ❑Beef Brood Co
Other El Turkey Poults Y
❑ Other ❑ Other
per Ctun?S: Numberof'Stru
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
N NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
J& 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ONo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
St cture 1 Structure 2 Structure 3 Structure 4
❑ Yes 99No ❑ NA ❑ NE
❑ Yes ❑ No rtructure
NA ElNE
Structure 5 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
oNo
❑ 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
1PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
10 No
❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Po
❑ 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
In No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q5 No
❑ NA
❑ NE
Comments (refer to question #t) Explain any YES answers and/or any recommendations ormny other comments '
Use drawin s;of facility to :better ex lain situations' use additional pages as necessa
1;.. t3' P ( P g ry)
ReviewerllnSpector Name iN - Phone: SS3:S�
Reviewer/inspector Signature: Date:
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 KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes b t No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JXNo ❑ 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
nNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JpNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
111
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
PP No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Nko
❑ NA
❑ NE
Page 3 of 3 12128104

)apivision of Water Quality
Facility Number O Division of Soil and Water Conservation
4 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eMRoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: tSda L
Arrival Time: t)�.DO n.� Departure Time: County:
1)1'— r
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Addres
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
aw,ne "pactry roputanon
❑ Wean to Finish
❑ Wean to Feeder
eederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ❑ Longitude: 0 ° ❑ ❑ W
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Puuets
❑ 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?
Cattle
Design °Current:"
Capacity. Populationt.z
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ILI
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?
El Yes T No ❑NA ❑NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
y NA
❑ NE
Fit�NA
ElNE
❑ Yes
❑ No
❑ Yes
q�No
❑ NA
❑ NE
❑ Yes
Ep No
[]NA
❑ NE
12128104 Continued

FaSility 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 ❑ No [� NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Pa 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
15 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
[P No
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require ❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
MlKo
❑ NA ❑ NE
maintenance/improvement?
IL
_ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12_
cc
Crop type(s) �l l`M , c�1^(1 ( -� f C) f S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IP No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
10 No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Nam�Osr/A Kr �Y II (� Phone: �7 to
Reviewer/Inspector Signature: Date:
121281010 Continued

Ficility Number: — Date of Inspection MEE
•~ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[§ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PQ No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�No
❑ NA
❑ NE
G
12128104

F
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up O Referral Q Emergency O Other El Denied Access
Date of Visit: 110 Arrival Time: ( 3 S Departure Time: 2: i� County:
Farm Name: Sou 1 qer 0' 9, "li) _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Phone:
Phone No:
Integrator: 9-d ,,���y—
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = S =it Longitude: [� ° = 4 ❑ u
W.s.
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattlew("Pacinnnopulation
❑ Wean to Finish ❑ Layer ❑Dai Cow
❑ Wean to Feeder 10 Non -Layer I Calf
71 Feeder to Finish W640 0,0 ❑ Dairy Heifer
El
Dry Cow
El Farr
Dry PaultryF,A�„�.--..:;,,�
ElNon-Dai
❑ La ers ElBeef Stocker
❑ on -Layers ❑ Pullets El Beef Feeder
�.
El Turkeys ❑ Beef Brood Cow
Other - ❑ TurkeyPoults
❑ Other ❑Other Number of S_truetures:
Farrow to Wean
ow to Feeder
❑Farrow to Finish
Gilts
❑
❑ Boars
Discharges &Stream Irnpac#s
Fft
Farrow to Wean
ow to Feeder
❑Farrow to Finish
Gilts
❑
❑ Boars
Discharges &Stream Irnpac#s
Fft
Discharges &Stream Irnpac#s
Fft

r �
1
Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IpNo
❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
F3 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J] No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[91 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
El NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VS No
❑ NA ❑ NE
maintenance/improvement?
] l _ Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) &„rmuAa Ho— _ St,.(( 14rn.t
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[b No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:1 Yes
�gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
16 No
❑ NA
❑ NE
Comments1refer to question # ): Explain any YES answers and/or any recommendations or any other c'ornments.."Q.
Use drawings of facility to better explain situations. (use additional pages as necessary) d
Reviewer/Inspector Name +� Phone: 2/0_913.3,
Reviewer/InSpector Signature. b 1 j Date:
rage l of .i 12128104 uonunuea

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ja No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes !!� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F] 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
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
b No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff) No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
FS1 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IR 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
55 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[19 No
❑ NA
❑ NE
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 O Routine O Complaint O Follow up O Referral O Emergency O Qther ❑ Denied Access
Date of Visit: Arrival Time: /a: / Departure Time: Count., �c�de..! Region: FRo
Farm Name: S 016 r01_ 9 1 v er Pa V Owner Email:
Owner Name: .5 n v- 4A,- 1�..y Cr C r o�'.j G•s Phone:
Mailing Address: �2 O.29 S E Alwn. 2 1 p_ r r � k
Physical Address:
Facility Contact:
Title:
Onsite Representative: nr.at•, orr- Cko �-
Certified Operator: S'., e.ns �e3
Back-up Operator:
Location of Farm:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Do ON Longitude: =00,
Latitude: Lan itude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish i
❑ Wean to Feeder
® Feeder to Finish .' q * D
❑ Farrow to Wean V
❑ Farrow to Feeder
❑ Farrow to Finish
. ❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
Beef Stoeket
rEl
Beef Feeder
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[% No
❑ NA
❑ NE
El Yes
®No
El NA
❑NE
i
12128104
Continued

s.
Facility Number: 9 -- ; j Date of Inspection �L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
7 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -'�,1 a.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[1 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) Q:.. , _ SG . w p
13.
Soil type(s) Wc. Q. N o 14 , ., b� Q.. Gac L
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
® Yes
&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
(2 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
c.aLo,.taea haves 'L"
na SI n-COCAJ C231� raASP Ir. A
�/` �• Q rG Q e .., 6Q a ^� i GJ a¢ n&� i •TT'G 4-e h o I' C c Ri V f rl♦ G Ps a �r a.iJ
Phone:
Reviewer/Inspector Name y % " ' �' � '� �.� ,
Reviewer/Inspector Signature: Date:
12128104 Continued

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

r
Type of Visit & Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or Visit.: 5 / O y Tune.
Facility Number CJ q SCo
0 Not Operational 0 Below Threshold
Gpl ermitted E316ertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .....W ......., _.
Farm Name: ..5o vL &L"ke .-....... ----------------- -- - - - County:
Owner Name:.....
f ............_._..._.......... Phone No: _..._...------.W........... ..•--•---• �...._............
'Mailing Address:.._rO..... Se ....+a%.. I 0 . _. . Nit/ ! el%� .__. .. --a $ �I y
Facilih Contact: .. a0t! ..� rs� t �rtr s���r�? Title:...- - ............-- -- -- — Phone No:
Onsite Representative:....------- ��..t2 c7 ...��nr1 ��� _.. _. _.. Integrator:... �:9-
Certified Operator.............IQ � lad .... .. Pr P3&y.e--------- ----- ------- Operator Certification
Location of Farm:
❑3wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �` �" Longitude �• �` �`�
Des R Current :poultry' µ`-Diap Pd ulatiun Cattle ,'� Cnrre3it,
Swine Ca " a Po Mahon .. CaT act Po uiat:on :J
Wean to Feeder ❑Layer ❑ Dairy
E2156-eder to Finish p ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Other
Farrow to Feeder -
Farrow to Finish Total D_ Ca aC1t
y
r. P. � Y
Gilts
Boars _. ° ry , M , _ Total SSLW
:. ...
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0-90—
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? [:]Yes Leto
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) El Yes 0<0
c. if discharge is observed, what is the estimated flow in gai/min? f
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes G-N—o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 5
Identifier: ............ ...I .................. .... ......................... -... ... ... .................... .......
Freeboard (inches):
12112103 Continued

Facility Number: -s&
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0" '0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E[N6-
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes To
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [moo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Edo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelunprovement? ❑ Yes El lvo
I 1 _ Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes []-N6--
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Croptype �errnuc�a i� t; rc+,' 411 } SOv6BGi.et pc�r� pf cc �tMnary /art
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes 044V
14, a) Does the facility lack adequate acreage for land application? ❑ Yes Q_W
b) Does the facility need a wettable acre determination? ❑ Yes E].No
c) This facility is pended for a wettable acre determination? ❑ Yes am
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes B No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [g.Nts
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ago,
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 Q-N6
Air Quality representative immediately.
Arst-oge S w�rlC,',y w.114
v6�e S 6,.,4—
r.P/v/, "Ve Se"j"J 6Cr,"j,
0.1Ij COL, e/'.
T� e e VP-SP e' ,'-7 es
❑ Final Notes
f
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S- - lg
12112103 Continued

Facility Number: D — _T6 Date of Inspection 3 / -D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑-No—
22. Does thepcility fail to hav all components of the Certified Animal Waste Management Plan readily available?
(ie/ , checWsis, de$i n, mMs, etc.)
[:]Yes
Q 6
23. Does record keeping n7d improveme . If yes, check the appropriate bo low.
❑ Yes
E'o
❑ Waste Application Free and ❑ Waste An�s ❑ Soil g
3-�G -27. 5— t17-7,3 2.r`/ �j /!e 7 f.% 7-7-2 7?.O
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q-Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Q-No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[14o
28. Does facility require a follow-up visit by same agency?
❑ Yes
l.No
29- Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[, [Nl5r
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
0446-
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

O�0� WAr�9QG Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
r
Alan W. Klimek, P.E. Director
p -f Division of Water Quality
July 18, 2003
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Bobby Prestage
2028 SE Hwy 210
Harrells, NC 28444
Subject: Rescission of Notice of Violation /
Issuance of Notice of Deficiency
South River Farm
Facility Number 09-56
Bladen County
Dear Mr. Prestage:
Thank you for your recent submittal of the information requested in our letter dated April 15,
2003. We greatly appreciate the effort that you made in compiling this information and sending
it to our Fayetteville Regional Office by the date required. We also appreciate the fact that you
reported the problem with high freeboard to our staff as required by your permit and worked with
our staff to manage the problem once it occurred.
Upon review and consideration of the information submitted, the Fayetteville Regional Office
has determined that no further compliance/enforcement actions will be taken by the Division for
these high freeboards.
Also, based on your actions to properly operate your facility, the Division of Water Quality
hereby rescinds the Notice of Violation that- was issued to you on April 15, 2003, and replaces it
with this Notice of Deficiency.
In the future, please continue to evaluate ways to maintain freeboard levels in the required range.
These methods include, but are not limited to, water conservation practices, adding additional
application sites, updating your cropping systems, adding additional and/or more flexible
application equipment, and maintaining the lagoon levels at the lowest allowable and appropriate
levels throughout the year. Our staff looks forward to continuing to work with you and your
Technical Specialist to evaluate and implement any needed changes to your system.
A*
WE--6-
Customer Service: Mailing Address: Telephone: [phone] Location:
1 800 623-7748 1617 Mail Service Center Fax: [phone] N. Salisbury St.
Raleigh, NC 27699-1617 State Courier #52-01-01 Raleigh, NC 27699-1617
An Equal Opportunity! Affirmative Action Employer
50% recycled 110% post -consumer paper
http://h 2 o. e n r. state. n c. us

Inadequate Freeboard
Page 2
Thank you again for your cooperation. If you have any questions, please do not hesitate to
contact the staff of our Fayetteville Regional Office at 910-486-1541.
Sin_=d
Paul E. Rawls
Water Quality Regional Supervisor
cc: FRO CAFO File: 09-56
Non -Discharge Compliance and Enforcement Unit
Central Files

■
A
State of North Carolina
Department of Environment
and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
DIVISION OF WATER QUALITY
January 9, 1998
CERTIFIED
�.I
Mr. Bobby Prestage
South River Farms
2028 S.E. Hwy 210
Harrells, NC 28444
Subject: Notice of Violation
Administrative Code 15A NCAC 2H .0217
South River Swine Farm
09-56
Bladen County
Dear Mr. Prestage:
You are hereby notified that, having been deemed permitted to have a non discharge permit for the
subject animal waste disposal system pursuant to 15A NCAC 2H .0217, you have been found to be in
violation of your 211.0217 Permit.
On November 21, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
performed an inspection of your farm located off Hwy 210 in Bladen County as a result of identifying
swine waste ponding adjacent to Highway 210 at the entrance to your farce. The inspection revealed
animal waste had been applied in such a manner that caused significant amounts of wastewater to runoff
the spray field and enter a road ditch adjacent to Hwy 210 approximately 150 feet from a blue line
stream, namely an unnamed tributary of South River. Mr. Prestage was available at the time of the
inspection and indicated that a truck had broken a sprinkler head while removing dead carcasses which
resulted in the discharge. The majority of the waste water was blocked from entering the creek by Mr.
Prestage and was pumped back into the spray field. To prevent discharge problems in the future, it may
become necessary to relocate either the dead box or the sprinkler head a safe distance from the traffic
lane.
225 Green Street, Suite 714 FAX [phone]
Fayetteville, North Carolina 28301-5043 An Equal Opportunity Affirmative Action Employer
Telephone [phone]% recycled119% post -consumer paper

Mr. Prestage
Page 2
1 /7/98
The Division of Water Quality requests that the following items be addressed:
1. Make any modifications needed to ensure there will be no future discharges.
Failure to comply with the above conditions may result in the facility losing it's deemed permitted status
and being required to obtain an individual non discharge permit for the facility.
Please be advised that this notice does not prevent the Division of Water Quality from taking enforcement
actions for this violation or any past or future violation. Furthermore, the Division of Water Quality has
the authority to levy a civil penalty of not more than $10,000.00 per day per violation.
Please provide a written response to this office on or before February 15, 1998 regarding corrective
actions taken or planned. If you have any questions concerning this matter, please do not hesitate to
contact either myself or Mr. Robert Heath, Environmental Specialist, at [phone].
Sincerely,
ai...�. 4,tu-.-
K T. St ens
Regional Supervisor
cc: Sue Homewood - Compliance Group
Sam Warren - Bladen Co. MRCS
Audrey Oxendine - DSWC Fayetteville Office
Central Files - Raleigh

f
State of North Carolina
Department of Environment
and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
J'�; •
E)E--=NR
DIVISION OF WATER QUALITY
January 9, 1998
CERTIFIED_:__i
awily
I r
Mr. Terry Matthews
D & L Farms
3959 Howard Road
Autryville, NC 28318
Subject: Notice of Violation
Administrative Code 15A NCAC 2H .0217
D & F Swine Farm
Facility No. 82-693
Sampson County
Dear Mr. Matthews:
You are hereby notified that, having been permitted to have a non discharge permit for the subject animal
waste disposal system pursuant to 15A NCAC 2H .0217, you have been found to be in violation of your
2H .0217 Permit.
On December 3, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
performed an annual inspection of your farm located off SR1431 (Howard Road). The inspection
revealed that animal waste had been applied from the Johnny Tyndall Farm onto land designated in the
certified animal waste management plan (CAWMP) for the D & L Farm which is a violation of your
Permit. The underground irrigation system has been combined with the Johnny Tyndall Farm and
hydrants have been installed in a cutover area that is not in the plan which is in violation of the CAWMP.
The lagoon dikes have not been planted in a suitable cover grass and were devoid of vegetation and field
## 1 was not established in Bermuda grass as required in the CAWMP.
225 Green Street, Suite 714 FAX [phone]
Fayetteville, North Carolina 29301-5043 An Equal Opportunity Affirmative Action Employer
Telephone [phone]% recycled110% post -consumer paper

Mr. Matthews
Page 2
117198
The Division of Water Quality requests that the following items be addressed:
1. Immediately terminate the application of waste from the Johnny Tyndall Farm onto the spray fields
identified in the CAWMP for D & L Farms.
2. Make any modifications to the irrigation system needed to ensure that there will be no waste applied
onto acreage not in the CAWMP.
3. Plant a suitable cover grass on the lagoon dikes and establish the required bermuda grass in fields per
CAWMP.
Please be advised that this notice does not prevent the Division of Water Quality from taking enforcement
actions for this violation or any past or future violation. Furthermore, the Division of Water Quality has
the authority to levy a civil penalty of not more than $10,000.00 per day per violation.
Please provide a written response to this office on or before February 15, 1998 regarding corrective
actions taken or planned. if you have any questions concerning this matter, please do not hesitate to
contact either myself or Mr. Bob Heath, Environmental Specialist, at [phone].
Sincerely,
Ke T. St ens
Regional Supervisor
cc: Sue Homewood - Compliance Group
Wilson Spencer - Sampson Co. NRCS
Audrey Oxendine - DSWC Fayetteville Office
Central Files - Raleigh

f Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 0
Time of Inspection : z0 124 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered ❑ Applied for Permit (ex:I.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name--... .�au� � �/�� .l. Ei�� ^-- County:...__ . I�La�h!� .. ..... _.....
Land Owner Name:... ._.L._ 6L __ � .... _.. Phone No:
Facility Conctact:.� _.. L6.. .s��......_... Title Phone No•C9�1.y�
Mailing Address: W G�...L�..... _.1l f._ _ _ ... _ _.— .... _ ..7 _._ . _ ..........
Onsite Representative:.-- Integrator:
Cerdfied Operator: °���?� . r ..._......_ .., Operator Certification Number:
Latitude 0 4 Longitude • 4 1�
Type of Operation and Design Capacity
ar � • DeS [ilrrent s � uDesc n CQC Cent w �a�3 ' DeSlgn MIA, ent
Ca'aci . Po" iilaton2'iPaultr}':. Ca aPo elation a"yCatfle Ca aci Pa lation
i ❑ ❑ Wean to Feeder WNon-Layer
Layer Diry
® Feeder to Finish p-i}j ❑Non -Da
Farrow to Wean
Cap Farrow to Feeder xTota Deslgn&acity
v k M"�
Farrow to FinishIM
,H� F To>aISSLW
❑ OtherE=x� 4x a
777
°Numbei°ofLagoo s �Haldmg Pod ❑ Subsurface Drains Present tt
❑ Lagoon Area ❑Spray Field Area
eneral
1. Are there any buffets that need maintenance/improvement?
'2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
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
4/30/9 7 maintenance/improvement?
❑ Yes KNo
❑ Yes N[No
❑ Yes J§No
❑ Yes kNo
❑ Yes kNo
❑ Yes X No
}
❑ Yes tKNo
El Yes *No
Continued on back

Facility Number:..
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
'X``
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes XNo
Sutures
(Lagoons and/or Holding. Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ANo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes XNo
11.
Is erosions, or any other threats to the integrity of any of the structures observed?
❑ Yes MNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes )tkNo
(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 Iack adequate minimum or maximum liquid level markers?
❑ Yes JgNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes kNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type -- — ------- ---- ..
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes No
18.
Does the receiving crop need improvement?
�o
19.
Is there a lack of available waste application equipment?
❑ Yes JVNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes A No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes gNo
For Coed Facilities 0111y
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes XNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes WNo
24.
Does record keeping need improvement?
Yes ❑ No
Comments refer. to' es'hion Ex lain an YES'answers and/or.an recommendations or any other comments t
{, qu p Y Y
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R :. • -
Reviewer/Inspector Name _ � a�?#
Reviewer/Inspector Signature: f���% �iK��G/JV Date:
cc: Division of Water Quality, Water Qualtyo, Section, Facility Assessment Unit 4/30/97