090059_INSPECTIONS_20171231

type of visit. �_-Tt_:ompuance inspection v uperatton tcevrew v structure Lvaruatron U lecamcat Assistance
Reason for Visit: 0-1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (o / Arrival Time: d D Departure Time: Z'v_& County: Region
Farm Name: ,Al"J r Owner Email:
Owner Name: ,//i %z ,� ��Q/� Phone:
Mailing Address:
Physical Address:
Facility Contact: �i�,`��r----r�dd Title:Phone:
Onsite Representative: integrator: a6L''z
Certified Operator: ti« Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I?O
(o
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
"''
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Non -Dairy
D . Ronl Ga act Po
Layers
Non -Layers
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
a .
Turke s
Turkey Pouets
Other
Other
..� _.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 B_No D NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes oNa
[::]Yes [+No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

' Facility Number: - Date of Inspection: — (—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ 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): 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
,LNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Rio
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r.!%ylf� la
13. Soil Type(s): - 1V o ,4 --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �C No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M—No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Jallo ❑ NA ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C4 No
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U�T_No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 5L - Date of Inspection: Y �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Dg-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 �Io
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerAnspector fail to discuss reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes L=F ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes f�jNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
D Yes
JELNo
❑ NA
❑ NE
❑ Yes
J . Two
❑ NA
❑ NE
Comments (refer any, YES answers and/or an addrtional•recomtneadations or any other eoznmeot&
Use:drawings'of facW::o better explsin sii#e�ationsi(use additional pages,ss necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date: _,2— /Z,
21412015

Type of Visit: Q'Compliance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:— J Arrival Time: ,'�� Departure Time: County: Region:
Farm Name: _t��pQ�`�/' T) �i�lrs�rY
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ; %� �,-dld Title: Phone:
Onsite Representative: �.
Certified Operator: ��1
Back-up Operator:
Location of Farm:
Integrator: 52 V,��
Certification Number: /G
Certification Number:
Latitude: Longitude:
} Desi n C•urrent Y g
Design CurrenE
P Design Current
Swtne Ca acit Po
}
Wet Poultr Ca ace Pop
P ty
CattleCapacit5 Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
-- :
Dairy Calf
Feeder to Finish
N kDesighlc:, urgent ,,
DrA PoWt - Ca pacit Pao .;
Dairy heifer
Dry Cow
49
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
IPullets
Beef Brood Cow
Turkeys
�P
Other
U.
'
ITurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes. notify D W R)
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
2No
❑NA
❑NE
[] Yes
5INo
❑ NA
[] NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
'
Waste Collection & Treatment
Y 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg-No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lb No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
0 NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[j]L.No
D 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. [aYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
®-Outside of Acceptable Crop/ Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /p„dzrs��r-
13. Soil Type(s): N Q ;±
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ea 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 Qq No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E;a No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pen -nit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Jbil'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 J2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes - O No ❑ NA ❑ NE
25_ is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [gNo ❑ 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 PUT ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C&No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JaNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes E.No ❑ NA ❑ NE
[:]Yes CO -No
[:]Yes allo
[:]Yes ZI No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
/�: /,�J
Reviewer/inspector Name:
Phone: �d —_ -?0J a1S7
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: Q9Tompliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: [ Departure Time:[/2; County: Region:
Farm Name:` / Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: a);11,,` r-- JN--a -VI Title: e-i-- Phone:
Onsite Representative: -1� f.�.�� _ - Integrator:
Certified Operator: _ lam' _ _ F Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to feeder
z)
I INon-Layer I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. I;oul
Ca aci
P,o
Non -Da'
Beef Stocker
4
Farrow to Finish
Gilts
Layers
Non -Layers
I
Beef Feeder
Beef Brood Cow
Boars IPullets
Turke s
Other
Turke Poults
Other
Other
Discharges Stream Impacts
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)
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 fo No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes MNo [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Ds ection: r
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): 1�t -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
rNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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
[Z 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 ® 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 ❑ Evidencee of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): p
14. Do the receiving crops differ from those designated in the CAV;W? ❑ 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 KI No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes C'No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Z No ❑ NA ❑ NE
the appropriate box_
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

. Facifi Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V1 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 JZ 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 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ef 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
RNo
❑ 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).. s-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: _-g0-0
Date:
21412014
Page 3 of 3

r
t
I Type of Visit �C�outiue
a Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up () Referral Q Emergency O Other O Denied Access
Date of Visit:
Arrival Time:
Departure Time: D
County:-
Farm Name: lrVj�'
P✓ T] f [ a4z3
e1"Y
Owner Email:
Owner Name:
y! )// e 1 �rs
Phone:
Mailing Address:
Physical Address: , �r
Facility Contact: ft� i'!/ i L- L►o, Title: �LIJ�Ir'� Phone:
Onsite Representative: S Integrator:
Certified Operator: S' � _ _ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:�V
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder t7
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poaltry
La er
Non -La er
©, 1'oultr
Layers
Design
Capacity
Design
Ca aci
Current
Pap.
Current
P,o
Design
Cattle Capacity
Dairy Cow
airy Calf
Dairy Heifer
Dry Cow
Non -Da
Beef Stocker
Current
W.
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
EL
Beef Feeder
Beef Brood Co —
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
❑
❑ NA
❑ NE
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
lam`
,❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IgNo� 1, t❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: 9F - J. Date of Ins ection:
_Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes &No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes +o 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
21 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
O 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
P 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 [K No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes Ug-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Callo ❑ 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?
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes g.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? 1f yes, check the appropriate box below. ❑ Yes UNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes S No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Ot jDateof Inspection: — -/:37
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Lg 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
[allo
0 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
Eg 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
0 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
allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

l ype ui v isu: k&x.4compuance inspection l.J uperation Keview V structure r vaivation lJ i ecunical Asslsiauce
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: p= / Arrival Time: 3 D Departure Time: County:
Farm Name: f Ja eS Owner Email:
Owner Name: f�(�; &' e _ G ���/� Phone:
Mailing Address:
Physical Address:
Facility Contact: X1 I f ' e—_ Title: fj-GCJH ��
Integrator:
Certification Number:
Onsite Representative: S� �—
Certified Operator: ®•---,✓
Region:
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current . Design . Current Design Current
Swine Ca aci Po Wet Poult Ca aci Po Cattle Ca aci Po
P h' P• ry :: ifft_AZ 3 P• P fY p-
Wean to Finish
La er
Da' Cow
Wean to Feeder
Nan -La er Dai Calf
'" "`""" " ' "` Dai Heifer
Design .Current Cow
D . P,oulWCa acit ro,-P,a Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
--
Turkeys
Turkey Puults
10ther
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
- - -
Other
ji'M
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)?
❑ Yes }KNo ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
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 2,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [K No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural frceboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5;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
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 12g-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) ff
"Onmalla / OcIcl— ,2z
13. Soil Type(s): �nk
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 5? No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes (&No ❑ NA ❑ NE
❑ Yes C5 .No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O-No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
allo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design [-]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
[DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes n No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• .Facility Number: - =1 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 [El 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewertinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[—]Yes
KNo
❑ NA
❑ NE
❑ Yes
ID No
❑ NA
❑ NE
❑ Yes
(a No
❑ NA
[] NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CZ[ No ❑ NA ❑ NE
❑ Yes ELNo
❑ Yes [Z No
[:]Yes R5 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 9V-,gj37 330-,z
Date: oZ
21412011

type of visit: t_or-uompuance inspection V [operation xeview V structure Evatuanon V i ecnmcat Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: :tea County:
Farm Name: 1 Gf K A r Owner Email:
Owner Name: , Ali E1 �` - L �j ��Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: H; 2--r Title: QGUh rr Phone:
Onsite Representative: Integrator: �c�•f
Certified Operator: Lj �.. -�� Certification Number: A 2-1
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current _ Destga Current
Desig Current
Swme Capacity Pop. :.:-W..et Poultry Capacity l?op
a) 1ci'ty Pop.
1`-CaulMG
y
Dairy Cow
Wean to Finish
I
ILayer
I
I
Wean to Feeder
-- pI
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
s -
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
w
D P ul > " Ca aet PoP. "
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other' r
Turke Poults
Other
Other
Discharges and Stream lmDacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[RNo
❑ 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

Facility Number: - Date of inspection: — D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 En 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
[&No
r
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
jt�'7,j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):-
13. Soil Type(s): iDIA24-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16- Did the facility fail to secure and/or operate per the irrigation design or wettable Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
O_No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
a 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 jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;KNo
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: 16t- 3 Date 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 to provide documentation of an actively certified operator in charge?
❑ Yes
EQ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other lssues
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)
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
M 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
S u,-�o�}-r A! e �'r_ �✓ shims w` P e_ 1".-wjo
A, E �Q-•---- N ofi 4 LJ &ice .
7-C,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �33c7a
Date:
21412011

Type of Visit Q t— ompliance Inspection Q Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time: Departure Time: County:Region: D
Farm Name: Wit' pal n. - , / Owner Email:
Owner Name: Tx_Tf) % _Q !/D GCK.J _ Phone:
�'
Mailing Address:
Physical Address:
Facility Contact: 7� &,y t4 9 Title: 1VIZ-.* Phone No:
Onsite Representative: Integrator:
Certified Operator: s��s.L-- Operator Certification Number: 16 31'q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I = Longitude: 0 ° 0 ` = "
oil 9 IN
Design Current Design Current Design C*urrent
Swi©e 4 Capacity Population Wet Poultry` Capacity Population Cattle Capacity Population
FWean to Finish ❑ La er ❑ Da Cow
Wean to Feeder QO ❑Nan -La er ❑ Dai Calf
❑ Feeder to Finish "....: Dairy Heifer
❑ Farrow to Wean ❑ D oul ❑ D Cow
� Farrow to Feeder
❑ La El Non -Dairy
ers
❑ Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑Non -Layers ❑ Beef Feeder
❑ Boars ❑Pullets
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ Other
❑Other Number -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
$Z No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UZ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L2-No
❑ 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? ❑ 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): ; j
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 J9No ❑ 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 rK 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 El Yes
No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
O No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 of Wind Drift El Application Outside of Area
12. Crop type(s) & 'W'Vj� /%9i/L'1fCtd
13. Soil type(s) %014"
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [0 Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[ZNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
EgNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
10 No
❑ NA ❑ NE
t!rrn u of a S ►- ; W yak ./
,s MV0-_: r_ Ale 7o— 74,e_ ue t P
Reviewer/Inspector Name a..�� Phone: gp�3 33
Reviewer/Inspector Signature: Date: =.;2
Page 2 of J 1z1,15iu4 uonrinuea

Facility Number: — Date of Inspection—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ej 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 El Checklists El Design ❑Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
N 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
IQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
91-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
® 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
t4 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
94No
❑ 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
aNO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
JZ Yes
Hfto
❑ NA
❑ NE
.47
d
�3. L a LL)-. FV 11 M) --t'cp �s su���
Page 3 of 3 12128104

Facility*Nunib&
�:Dtvtsloa of Stiil�a
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale of Visit: — K ArrivA "Time: Departure Time: ! D Count,,: Region: Z
Farm Name: . da4ke jcfal'ny'= _ Owner Entail:
Owner Name: / 0 L10—
T'_z UZ Phone:
;Mailing Address:
Physical Address:
Farilitv Contact: �rD� !�l'%%� Title: Phone No:
onsitc Representative: Integrator:
Certified Operator: Operator Certifica on Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑o ❑ Longitude: ❑ o ❑ , ❑ `
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder & —D r
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Daig Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J,No
❑ NA
❑ NE
❑ Yes
(g No
❑ NA
❑ NE
12128104 Continued

Facility Number: C3—
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes (gNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
Spillway?:
Designed Freeboard 0n):
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 D9 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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ®No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5? No ❑ NA ❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failureto Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s) Po A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El 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):
cc .1/"/ rZa1,�; d- .� f, arm
e_-.en,,.>1: / ; n-- cC e-
l r �
IQ Ka j 5%S
C�%%7�S N■il �{ ,Vd-je- y 19a Z/Q�� �Drrrts�
Reviewer/inspector Name
Phone: 0-- —_773 00
Reviewertinspector Signature:
Date: n2
� 12128104 Conanuea

Facility Number: Date of Inspection.
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ® Yes E066 ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes tho ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 10 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ER No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fZ 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
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12128104

ivision of Water Quality f�G
Facility Number O Division of Soil and Water Conservation D9
0 Other Agency
M,
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: , ,3 O County: Region: ,E-e-1 T
Farm Name: 11 ZVILS f� r at or er -- Owner Email:
Owner Name: / %�D y I/ �lX r __ Phone:
Mailing Address:
Physical Address: Facility Contact: Z7±z ka Title: V6lMh3Cw _ Phone No:
Onsite Representative: ��'��r Integrator:
Certified Operator: L Operator Certi cation Number: �iC 3l
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = & = I, Longitude: = ° = I = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design�.:; Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
Non-L,
Pullets
U Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Currei
Cattle Capacity Populati
❑ Dairy Cow
❑ Dairy Calf
E]Dairy Heifej
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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 P4.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L2!kNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PU-qo ❑ 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): f / _
Observed Freeboard (in): �.�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O,No ❑ NA ❑ NE
(ic/ 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 EX 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 [K No ❑ NA ❑ NE
maintenance/improvement?
IL is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ""'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window []Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) yQ�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Off 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
? OYes
jdlt ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
1�0 No
❑ NA.
❑ NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
fZNo
❑ NA
❑ NE
:Comments (refer tu:questton.#) : rtitplatn auy YES answersmnd/o`0.any-Irecommendations or any other comments.
F _e ��: _ . =- ' - _. :_- _„„ .7� Wes,., .
Use drawings of facility to better explain situations: (use atldrteonal pages as necessary)•
/fie CA-tr7;n f cJar' '_ f:,
JSoh c y^' 4o,tL.� r •w c Tl1 e.zr "Jjt dd It- a�c
016rZVa ulew; rou r�
Reviewer/Inspector Namef, " Phone C%jQ-�`-0D
Reviewer/Inspector Signature: Date: s
IL/L3/U4 "minaeu

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. •Yes ❑ No ❑ NA ❑ NE
W 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 KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 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
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X) No
❑ NA ❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 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
ER No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14 No
❑ NA ❑ NE
12128104

Type of Visit
fm opliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Q46n�utine O complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: —lG'fl Arrival Time: rr0 i 00 Departure Time: ,� D County: AK- Region: rX'o
Farm Name:Owner Email:
Owner Name: ti� �C�/ _ Phone:
Mailing Address:
Physical Address: // y
Facility Contact: � !/O f Sul Title:
Onsite Representative:
Certified Operator: . fazEg=
Back-up Operator:
Phone No
Integrator: Go4%/A�,yr'._
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' 0 " Longitude: 0 ° = ' = u
Design Current
u - Design
•
Current Design Current
Swine Capacity Population
Wet -.Poultry, Capacity
f
Population_ Cattle - = Capacity Population
❑ Wean to Finish
❑ La er
❑ Da Cow
Wean to Feeder
'DO
'—'�!
-Layer
❑ DairyCalf
❑ Feeder to Finish
r
❑ DairyHeifer
Y ❑ Farrow to Wean
i)r}Poultry -
❑ D Cow
❑ Farrow to Feeder
� El Non -Dairy
t ❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -La ers
El Beef Feeder
❑Boars
❑ Pullets
❑ Beef Brood Co
•
❑ Turke s
,=
Other
❑Turke Poults
-
Number o�Structures: LIMI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2!�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2LNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection -_D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 54No ❑ 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 Eq 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 E�kNo ❑ 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
UqNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
M No
El 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) 3,�r4V_e40"A&V�_j
13. Soil type(s) PJ p �
14. Do the receiving crops differ from those designated in the CAWIVIP? ❑ Yes
[ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? KYes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?Q Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA ❑ NE
S �C�'bt 8�`��'� �(j tr✓' �wc^�. i r� ! K-r W � 4-{�i�.S i �
T
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection �g
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes fi§ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O 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
J4 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IO 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
W No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f0 No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality '59&,
Facility Number I / S/ Q Division of Soil and Water Conservation 7_ a
C) Other Agency
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r1U`o Arrival Time: Q Departure Time: 3:'FTa Count}': Region: '
Farm Name: HA5 14-N er rae nif , / y Owner Email:
V
Owner Name: ro D Phone: b2',27_Z Z LP",:9-2
Mailing Address:
Physical Address: �-
Facility Contact: �!'c)V Vm J4,-! Title:
^i
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 ' E--] « Longitude: 0 ° 0 I = 0
Swine
Design Current Design" Current
Capacity Population Wet Poultry Capacity Population
❑ La er
[oD 3'j% ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Curreni
Cattle Capacity Popon
ulati'
El Dairy Cow
❑ DairyCalf
❑ DairyHeifei
El Dry Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:E4-1.
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
K No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ 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): .12
Observed Freeboard (in): �`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
9 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
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J91 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
P9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Dj No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W 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) r rrt a Jd �!>�/rd'4-� r""/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 14 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 ? ❑ YesER No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Z[No ❑ NA ❑ NE
�S Zfev� Z g� � (97t22j.5 d- W &,- {, j i I'\- �/'�y1 ua�aC� nt�i 5 dr/ rc Ica
/%%1`s kb Id�v i'r"% Zry rnu4
/"� S�Ce� 1 of . /V�x`f r .a
you ea'.�C"fl R i F. �x�,rr,,� for
Reviewer/Inspector Name Phone: D�
Reviewer/Inspector Signature: Date: % /V ®m7
Page 2 of-3 12128104 Continued

Facility Number: — Date of Inspection D D
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. []Yes DSNo ❑ 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
Pj�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
j4-No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�4 No
❑ NA
❑ NE
26. -Did the facility fail to have an actively certified operator in charge?
❑ Yes
59 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§0 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
[8 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Comments and/or Drawings:
Pee. � ou ,,J
r
/vit tvv� G¢Ol.un b efvw • 4"sf zdl,
PW l Ivred' 2 C.0 0_` _ � Oc G'r's ©'� �''L yDu l Nib/
il�Irva64J /"Lj
12128104

Type of Visit j2Kompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time: County: 45 +'—
Region: fz--'Vo
Farm Name: &U.S
zf r—_ Fd_ rH'L-
Owner Email:
Owner Name:
Mailing Address: T._D,
Physical Address: ��d3 �yZ/
Facility Contact: 22P7 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder (.
❑ Feeder to Finish i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number: (63'*V
Back-up Certification Number:
Latitude: ❑ o = ' E::] µ Longitude: ❑ ° = L = «
Design Current
Wet Poultry Capacity Population
❑ Layer
i
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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: 5
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 JQ No ❑ NA ❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
❑ Yes
L. No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[d.No
❑ Yes
CO No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection •DT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
MNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
14 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
9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) .
13. Soil type(s) �Ql�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination. ❑ Yes
RI No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J9 No
❑ NA ❑ NE
64
Reviewer/Inspector Name r Phone: 47/-O
Reviewer/Inspector Signature: Date: /':F-7^-la✓
12128104 Continned

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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
EgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PqNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[*No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes]
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
M NA
❑ NE
Other Issues
`s
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V 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
4 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
M No
❑ NA
❑ NE
General Permit? (le/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
6ANo
❑ NA
❑ NE
Coinmentsaandlor Drawin ��. �,�`�
12128104

Division of Water Quality
IFaCllify Number Q / S Divisiono_f Soil aad Wafer Conservation
� Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: S'3Q County: 61Qdr^1
Farm Name: GY Owner Email:
Owner Name: vu Phone:
Mailing Address:
Physical Address:
Facility Contact: ,o K Vo /a +.J Title:
Onsite Representative: r k f�0A, i..j
Certified Operator:
Back-up Operator:
Region: FAO
Phone No: P
Integrator:���
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = u Longitude: = 0 0
Desigis` , C•urrent Design Current 0DesigWPPI�555-
ent
Swine Capacity# populationaiwtitppomuitllyCapacity Population Cattle Capacation
Fr --]Wean to Finish ❑ Layer ❑ DairyCow
Wean to Feeder �(p00 DO ❑Non -Layer ❑ DairyCalf
[� Feeder to Finish Dairy Heifer
❑Farrow to Wean i.y � r.y
❑ D Cow
r`�D,�oult .
❑Farrow to Feeder '`� °� El Non -Dairy
El Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts Non -Layers El Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cowl
_.:& A ❑ Turkeys
Other R. �' ❑ Turkey Poults
❑ Other r` ❑ Other Number of Structures:
Discharges & Stream lm acts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Y No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[$No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gations)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
121No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LP
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

C �
Facility Number: Date of Inspection 112 -lS—alo
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2fNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes W No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�i
Observed Freeboard (in): 2la
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(51 No
❑ NA ❑ NE
(iel 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
P No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P 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
[I'94No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[NNo
❑ 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) j5Lk/Kta J 4_ _S_Ltf F11 e!svr,•iv (41S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EPNo
❑ 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
[]PNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2VNo
❑ NA
❑ NE
Reviewer/Inspector Name !� 1`C.b��e,v Phone: �`310� "}33 -333 0
Reviewer/Inspector Signature: Date: %Z —le a (p
Pane 2 af3 12/28/Od Continued

Facility Number: g — 5 q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PPNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
OR No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UPNo
❑ 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
CR No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerA n spector fail to discuss review/inspection with an on -site representative?
❑ Yes
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(YNo
❑ NA
❑ NE
Page 3 of 3 12128104

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Air Quality
Michael F. Easley, Govemor William G. Ross, Jr., Secretary
B. Keith Overcash, P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
February 23, 2004 R EC E IVD
Mr. Troy D. &Anna K. Votaw
FEB 2 5 2004
Husker Farm . DENR
150 Bayridge Road FAYMEVILLE REGIONAL OFFICE
Harrells, North Carolina 28444
Subject: Approval of Best Management Plan in Response to Determination of Objectionable Odor
Husker Farm
Elizabethtown, NC, Bladen County 6 / 09-00000
Dear Mr. and Ms. Votaw:
The North Carolina Division of Air Quality (DAQ) received and has reviewed the required
Best Management Plan (BMP) as described in NCAC 2D.1803, Best Management Plans for
Animal Operations. Based upon this review, the DAQ approves the BMP, as submitted. All
practices and changes to minimize or reduce odor outlined in the plan must be completed within
six -months of this approval. You may be contacted by DAQ staff to determine the status and
compliance with the BMP.
If additional determinations of objectionable odor occur after fully implementing the plan, the
Director will determine whether these incidents constitutes aplan failure, requiring modification to
the BMP to incorporate additional odor management measures. Failure to complete the plan
within the specified time period will result in the Director declaring a plan failure, as specified
under the regulations, and require installation of Best Controls as outlined in the regulations.
Any violation of an air quality regulation is subject to the assessment of civil penalties per
North Carolina General Statute 143-215.114A. This General Statute provides that civil penalties
of not more than ten thousand ($10,000) may be assessed against any person who violates any
classification, standard, or limitation established pursuant to General Statute 143-215.107, Air
Quality Standards and Classifications. In addition, each day of continuing violation after written
notification from the Division of Air Quality shall be considered a separate offense. Neither this
letter, nor any subsequent action, absolves you from responsibility for any violation or damage to
public or private property or from any enforcement action available to this agency.
1641 Mail Service Center, Raleigh, North Carolina 27699-1641
2728 Capital Blvd., Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www.ncair.org
No e hCaro' 7
!l'tllraC�l�
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Mr. & Ms. Votaw
February 23, 2004
Page 2
We appreciate your attention to this environmental concern. If you have any questions with
respect to this matter or in meeting the BMP requirements, please contact Steven Vozzo,
Fayetteville Regional Office Supervisor (910-486-1541) or Gary Saunders at the Stationary Source
Compliance Branch (919-733-1497).
Sincerely,
B. ith Overcash, P.E.
BKO/gls
cc: Gary Saunders - RCO
DAQ Central Files (Bladen)
Steve Vozzo — FRO
bus Elliott -FRO

Michael F. Easley, Governor
Wiliam G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
August 22, 2003
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Troy D. Votaw
PO Box 161
Elizabethtown, NC 28337
Subject: Inadequate Freeboard
No Further Action
Husker Farm
09-59
Bladen County
Dear Mr. Votaw:
Alan W. Klimek, P.E. Director
Division of Water Quality
Thank you for your recent submittal of the information requested in our letter dated April 16,
2003. The Fayetteville Regional Office has determined that no further enforcement actions will
be taken by the Division for the inadequate freeboard.
However, upon review and consideration of the information submitted, the Fayetteville Regional
Office has determined that an NOV is appropriate due to poor operation and management.
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.
4GA
WDEN3
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 i Affirmative Action Employer
50% recycled 1 10% post -consumer paper
http:llh2o.enr. state. nc.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.
Sincerely
Paul . Rawls
Water Quality Regional Supervisor
cc: FRO File: 09-59
Non -Discharge Compliance and Enforcement Unit
DWQ Central Files