090061_INSPECTIONS_20171231

e
Date of Visit: Arrival Time: ;3-p Departure Time: ,'pc� County: -' r- Region:
Farm Name: �_� t1� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �[�Y1c� � . L r�c t1 Title: g;2 2\ .r Phone:
Onsite Representative: 1 (+lot L� Integrator: '�5WOZ7
Certified Operator: 1�,, � Certification Number: 37
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
"' Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder
❑
Non -Layer
„
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oult , Ca ci 1?0
`'
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
w
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
li►Other,i,
Turke Poults
`°.
I
i.nniM4�W
Other
-
Other,
'ui4Euai
-,4
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [a -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)
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
[a -No
] NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: _5
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to
❑ 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: f
Spillway?:
Designed Freeboard (in): C— f 2!
Observed Freeboard (in): �4� 3 c7 qo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EyNo
❑ 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
�fo
❑ 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
[]"<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[-11�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[5-'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
,Crop
�Window ❑ Evidences of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): GP2/
13. Soil Type(s): 0 W 7f- /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EE No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA LINE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-f-4o
❑ 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
�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA D NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ So I Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
1 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [3'l�lo
the appropriate box(es) below.
❑ FaiIurc 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 [a'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [2 0
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.
X Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 2r o ❑ NA ❑ NE
❑ Yes L2"'O ❑ NA ❑ NE
❑ Yes E5,14o ❑ NA ❑ NE
❑ Yes ff'&o ❑ NA ❑ NE
❑ Yes
�lo
❑ NA
❑ NE
[:]Yes
[jNo
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
Comment refer to acshoa E zpla sny Y-ES use additional pages di nenees recommendations o' II I{ r n other comments. {
1( 9 } P, Y r Y ray r�
Use dra es of faciLty, to better, ' �,'r' �
�rLLJfQj/ rJ1 ij,Qf�Yar� i Y� Q� ��Y r/ qw /OOL-
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: Q'Compliance Inspection O �Vouow-up
on Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 Departure Time:1 County: Region:
Farm Name: `, n.�auJ „ Nu r—sT,r y /, d 3 Owner Email:
Owner Name:l~� [; w� Phone:
Mailing Address:
Physical Address:
Facility Contact: 7pz/j Jre-Ay-f Title: Phone:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Currentt
=Design
Curren#
Design Current
Swine
Capacity
Pop.
Wet Poultryy
i apacity
1'op
Cable
Capacity Rap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
i-"
Farrow to Feeder
D Poul# . Ca aei
Pa
Non -Dairy
Farrow to Finish -
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.
Turke s;
Other
Turkey Poults
OtherI
I
10ther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
❑ No
[] NA
[�--
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
E]--XE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
0 NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number:I - Uate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] No ❑ NA
a. If yes, is waste level into the structural freeboard? [] 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 ❑ No ❑ NA ED-9-E
(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 [ E
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 E2-IqE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [3-++F-
(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 ❑-Nfi,--
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
[]-N7E--
❑ 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
❑ No
❑ NA
M-NI`
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[aVE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
ErJ-KE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
['NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[�r'E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
©"N�
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [ r N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA �E
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA FTINE
,I
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [:]No ❑ NA Ej NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[2'NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
[:]No
❑ NA
[3-1Q
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
[f 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
[ J E
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
[]'FI'
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 E3-?41ff-
0 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA E3-IqE
33. Did the ReviewerfInspector fail to discuss review/inspection with an on -site representative?
[—]Yes
[7 ' o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2?<o
❑ NA ❑ NE
r
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: &_/'- ';�Ze/dam
21412015

E� Facllt Number',• fi� G / , -._�n M,,:�� Divtston of„Sotl:and��?Vater Conservation��. ��' ��: �, -�- ,���
R
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time- ; l/j` County: egion: 7 �—
Farm Name: ; -I / / ,;Z 3 Owner Email:
Owner Name: P1 d=UVL 1< y ��� Phone:
Mailing Address:
Physical Address;
Facility Contact: 7,5? 1r? *, , � Title: t0kLO Phone:
Onsite Representative: rraL) SC-7 A,- 4 Integrator;� a&&
Certified Operator: �s � Certification Number: 9 3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
DesignNC-Urreiniff Design Current
Swine
Capacity Pop. Wet Poultry
Capacit,Pop
Cattle Capacity Pop.
Wean to Finish
I 11-ayer
jDairyCow
T
Wean to FeederI
jNon-Layer
I
Dairy Calf
Feeder to Finish
_
r;
D Paultr.
FDesign tiCu , ent : -
t_ 1'0 .��-
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
_—_
Gilts
Non -Layers
=-
Beef Feeder
Boars
140 Pullets
Beef Brood Cow
-�
-
Turkeys
Qther
w Turkey Poults
sy,,
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 ®No ❑ NA ❑ NE
[::]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
0 NA ❑ NE
[:IN A ❑ NE
Page I of 3 21412015 Continued

.y
lFacilityNumber: - Date of Inspection:
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): z 2i
Observed Freeboard (in): i A�LL
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
CK No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes � No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C&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 environn*ntal
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Cl No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% 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):/i7 /1.f//r
13. Soil Type(s): ��� ,/ j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (LNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes QC No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes EA No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection: — 1
r 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff� 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 Ea No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1771 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [S& No
❑ Yes JZ No
❑ Yes [&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 drawinjis of facilitv to better exulain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Sigttatui
Page 3 of 3
Phone: -) ,
Date: Z �_Z - 9?0 7 z
21412015

A
I
(Type of Visit: Q'Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: -z�L.J'—,
Farm Name: h i -,L ?1J u,-5. e_ e d -3 . Owner Email:
Owner Name: f KV� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: %-1-111.174= k, w�OLAO Title: e9(t)t'— Phone:
Onsite Representative. 7-� 4_u i i h , yt L, a c. rj Integrator: j ,yJ�1 j r1 dj
Certified Operator: �" � Certification Number: ig'
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
ttTt7
Non -La er
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr. P,nulta Ca aci P,o ,
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers I
Pullets
113eef Feeder
Boars
Beef Brood Cow
Othe
Turkeys
ITurkey Poults
r,
Other
Other
Discharges and Stream ImAaetS
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 ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes _5jNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

Facili Number: - Date of Ins ection: /.,
Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rNo ❑ 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 P. No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ELNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ELNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes UEJNo ❑ 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 O'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FRNo ❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. Roes [g[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): CDIt, "lv�"-0,— /i,
13. Soil Type(s):
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 E�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
ED No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Callo
❑ 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. 9—Yes o ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZINo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (a No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - 6 1 Date of Inspection:
. 24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes WNo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
' 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [5 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
0 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
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
)!-No
❑ NA
❑ NE
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Phone:��-��
Date: ,S ?__ _Aa16
214,12014
Page 3 of 3

Type of Visit: omp ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1, I Arrival Time: Departure Time: County: 4 1-.
Farm Name: �JII rS G1`�y / ¢� ,3 Owner Email:
Owner Name: �e4 rat _ 1-� i ,n.1.,A,. Phone:
Mailing Address:
Physical Address:
Facility Contact: tj,�Lr,n. k -, P t t, Title:
Phone:
Region:
Onsite Representative: ,�jLa�—� Integrator: 44��c�i�
Certified Operator: z�ez/,�x Tw LcrwJ Certification Number: Z _Z�^�
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Pop.
Design Current
Wet Poultry Capacity op.
Desi�Gburrer571apacity
attle Ca
Laer
Da' Cow
Ni
o0 l�
Non -La er
Da' Calf
Design Current
D . P,oul Ca aci Po
Layers
Da' Heifer
Dry Cow
Non -Dal
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facility Numher: - Date of Inspection:
Waste Collection & Treatment
r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M 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): 33 �� . ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a 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
[ gNo
❑ 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
jo No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 ❑ Application Outside of Approved Area
12. Crop Type(s)- 1-401/7
13. Soil Type(s):00 971t" f r'(% - _
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 allo ❑ 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 [Z No ❑ NA ❑ NE
[:]Yes S No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
Cg No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[X No
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®`No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JK No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for siudge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [K No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Z 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:
❑ Yes [a No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
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
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
r"No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1D a
Date:
21412011

Type of Visit: mnpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 !routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r Departure Time: ; p t7 County:
Farm Name: r n arm p� d' 3 Owner Email:
Owner Name: A 1—" h �� k ; rt L Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: lip�Title: 4E�12 n t'✓Phone:
Onsite Representative: �'G�-��_ Integrator:
Certified Operator: 'T34rL / ii �oruJ Certification Number: � }�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
2 Design
Current
Design Current
M
Swine Capacity Pop.
WetrP_aultry _ -..Capacity
Pop.
Cattle Capacity
MP.
Wean to Finish
La er
Dai Cow
U.Wean
to Feeder —D
Non -La er
Dai Calf
Feeder to Finish
- =. 3a
Dai Heifer
Farrow to Wean
Farrow to Feeder
= - Design
D . �P,oul :. =Ca aci_
Current
P,o -
Dry Cow
Non-Dal
Farrow to Finish
Gilts
La ers
Non -La ers
Beef Stocker
Beef Feeder
Boars
-
IPUIlets
Turke s
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
[] Yes
NNo
❑ 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
M No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faeili Number: - (a I Date of Inspection: / /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ER -No D. 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): 7 _ 3V
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 g 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 C2�No
E] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Z 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 allo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [Z 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): Y
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [gio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes h No
❑ Yes RNo
❑ Yes No
❑ Yes ® No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [S� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [$ No
❑ Yes t: No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

FacilityNumber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes JZ 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 LEgNo ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Eg 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
Pg 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
a 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
P 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
P No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10 >3D-0
Date:
21412011

a Number ®- tv O Dwrsion of Soi! and Water Conse`' 4 fk
' - � , � wrston of Water QuaL
ty
o Other enc
-.mill 1
Type of Visit: 6-mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: OlFrouti.ne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: ; 3 O
Departure Time: t D County: �,�
Region:
Farm Name
(
`; Owner Email:
Owner Name:
rn h, - " `a Li
_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
L. L e t s) Title:
Phone:
Onsite Representative: t 1 Integrator: ►�$tc1
Certified Operator: DeLf-a- Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
ItYS"Agopry.Capaciy PoWet Poult .
VoN
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
R
1JesEgn Current
D . P,oul Ca cif Pzo
La ers
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes nNo
[—]Yes ® No
❑ Yes No
❑ NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 0 -/
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No ❑ NA [3 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): 3fl c3
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
M 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. El Yes IN No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 6 u It- / % p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(S 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
21 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[8 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 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 5�,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [S No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Z7- Date of Inspection: 1 3 (> '-/3
. 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (.No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo
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 [8 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E&No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes [2.No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No
[:]Yes ® No
[:]Yes CA No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/inspector Signature: Date:
Page 3 of 3 21412011

t
type of visit: k:7--eompuance inspection V uperatton mevtew u atructure Lvatuanon u t eennicat Assistance
Reason for Visit: Dunne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 3 ; j0 Departure Time: ®D County:
rr--f1` 7T—
Farm Name: P;vt,Li-La jJur5err % gv�'J Owner Email:
Owner Name: Ke nnctl& n i rt "LiJ Phone:
Mailing Address:
Physical Address:
Facility Contact: wag _,4 f ( ; rt 1,� LV Title:
Onsite Representative:
Certified Operator: �1-6 /g f'(; ► L etiul
Phone:
Integrator
Region:
Certification Number: % % lv 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity IP,op.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
C•atlle Capacity Pap.
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
WE
Feeder to Finish
Farrow to Wean
D , P,oul , °
Design
Ca achy
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Boars
Beef Feeder
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Lallo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ["No
❑ Yes ®No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: 3�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U3.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): 4�2— At Ab
Observed Freeboard (in): 3 O------1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Cg 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 ❑ 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 ED No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fecN71 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 MYes ❑ No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 01 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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 "Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check
❑ Yes
IVI No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Jallo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking [—]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
EE�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
&No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number:- Date of Inspection: —_�—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
JZN
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes El No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑Yes FZNo ❑NA ❑NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes EN No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Ezplam anYES answers'and/orany'addthonalrecommendatzonsoranv other conninnenfs .
.:- . - • .a-�f1 . ., � P.tpS: ��f+t Kd: � }rAJ 'S. y eR � -
Use dra'win s`of-facilityJto'better explain-situations-,(use.,addEtipnal�pagesgas�necessary
Y—i 5 Ce,70�n el V- 1-cPa it'27 E
x%g/,r, j/p a G�/i �� itJ��� -t -�/`l' t►-- ' �r �-- �i,`' S y/�� l �
Arm rc 60 �9`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

i
Type of Visit (compliance 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: I Y100 I Departure Time: County: Region: f /�
Farm Name: '^ L�su1 iy 1S rszf�� . /1 12 Qf' Owner Email:
OwnerName; rn n s 1 tQ Ir��a� Phone:
Mailing Address:
Physical Address:
Facility Contact: �eflnfq'k K" "7 0 Title: 42461rl er' Phone No:
Onsite Representative: Integrator: IXAf/- 1
Certified Operator: 4Cc. k ''tiJ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1=1 Q = f ="
Longitude: = ° = I = u
Design Current
Design Current
Design Current
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
inish
❑ La er
❑Dai Caw
eeder
r'K[D]Farrowto
49O
a
❑ Non -La er
❑Dai Calf
Finish
❑ Dai Heifer
Wean
❑ D Cow
-
Feeder
❑ Layers
❑ Non -Dal
❑ Beef Stocker
❑ Farrow to Finish
ElNon-Layers
El Beef Feeder
❑Gilts
❑ Boars
El Pullets
❑ Beef Brood Co
T ::..„ -, .. ..,..
❑ Turke s
Other
❑ Other
❑ -Turkey Poults
❑Other
. Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;g No
❑ NA
❑ NE
❑ Yes
RNo
[]NA
❑ NE
12128104 Continued

Facility Number: 9— Date of Inspection tL-�
•� 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): �G
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [allo ❑ 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
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
f,No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[SNo
❑ NA ❑ NE
maintenance/improvement?
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
M-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) f ( eo' 8rj J
13. Soil type(s) �j ({ f F` rO
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Eallo
❑ 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
[RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
allo
❑ NA ❑ NE
Reviewer/Inspector Name Phone: /Dy_73 33Cp
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212AVU4 Uonanueu

Facility Number: — Date of Inspection
y 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 appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers 0 Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
&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
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
BNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Bio
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
EgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
[ZNo
❑ 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
U •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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,yk�/�--QJ ArrivalTiime: t fl Departure Time: % 0,1 DCJ I County: ' Region: r 0
Farm Name: i ►? �auJ,,,j Air-5 ,o rYOwner Email:
Mi Owner Name: — n c n -t / yx Phone:
Mailing Address:
Physical Address: 1
Facility Contact: r r1� -P h N GO Title: Phone No:
Onsite Representative: ,5�j�—�� _ Integrator:
Certified Operator: 6>-2 ��� Lm w'— Operator Certification Number:
Back-up Operator:
Location of Farm:
�o
Latitude:
Back-up Certification Number:
= u Longitude: = o = 1 = "
Swine
Design Current Design C►urrent Design
Capacity Population Wet Poultry Capacity Popnlatian Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑ DairyCow
Wean to Feeder
OO O p
Layer
❑ Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
FEEJ TurkeyPoults
Other
❑ DairyHeifer
❑ Farrow to Wean
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Beef Feeder
❑ Beef Brood Cowl
I
❑ Boars
Other
❑ Other
Number of Structures: OT—]
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 0No ❑ NA ❑ NE
El Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[]No
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: q' - l Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PSNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Stricturc l Stricture 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Desi6med Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 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
RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any or 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
5,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceof Wind Drift ❑ Application Outside of Area
12. Crop type(s) Jam/, W% ray/
13. Soil type(s) Su A / / .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R 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
Z No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
59 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5i.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):
b y 'l )e" 9,01 D
Reviewer/Inspector Name Phone: I I D-gff3-33 p'0
Reviewer/Inspector Signature: Date: �i -S- / a
12128104 continued

Facility Number: — (� j Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2 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 [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IRNo [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C3,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[]Yes
%BNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JZNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than nonnal?
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
SNo
❑ 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
BNO
❑ NA
❑ NE
12128104

AQ �...�
CDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee rreeman
Governor Director Secretary
January 26, 2010 RECEIVED
Kenneth Kinlaw 'IM 2 $ 2M
Kinlaw Nursery #1, #2, #3 O NR-FAYEiiEtiLLEREGIONALOFRCE
3160 Horseshoe Rd
Bladenboro, NC 28320
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS090061
Kinlaw Nursery #1, #2, #3
Animal Waste Management System
Biaden County
Dear Kenneth Kinlaw:
The Division of Water Quality (Division) received your sludge survey information on January
19. 2010. With the survey results, you requested an extension of the sludge survey requirement
for the three lagoons at Kinlaw Nursery 41, #2, #3 facility. Due to the amount of treatment
volume available, and the rate of sludge accumulation for lagoons No. 1 and No.3, the Division
feels that an extension is not appropriate for those two' lagoons at this time. However, the
Division feels the treatment volume and rate of sludge accumulation for lagoon No. 2 are
adequate such that a sludge survey is not needed for this lagoon until 2012.
The next sludge survey for the lagoons No. 1 and No. 3 at Kinlaw Nursery #1, #2, #3 facility
should be performed before December 31, 2010. The next sludge survey for lagoon.#2 should
be performed before December 31, 2012. Thank you for your attention to this matter. Please
call me at [phone] if you have any questions.
cerely, -
stine D. Blanton
Animal Feeding Operations Unit
cc: Fayetteville Regional Office, Aquifer Protection Section
Permit File AWS090061
1636 Mail Service Center, Raieiy-h, Nortn Carolina 27639-1636
Location,: 27,2 Capital Blv +.. Pa[eien, Nprttt Carolina 27604
Phone: 919-7-3-3"111=AX 91c-715-Q5861Custome; Sevice:1-87,-6,3-6748
Iniarn�i. wwv..nnvalPmuality nro
NorthCarolina
N17tul"l lly
An Foiwl Onrnmircv s Af ilMaWE Action Emonve,

Li , . . _ I 1 /
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: b-� Arrival Time: Departure Time: County: Region: R_ eD
Farm Name: 161l1 14 i✓ kUrs / 4 }} _ Owner Email.•
Owner Name: kfnfneth�! n f a %✓ Phone:
Mailing Address:
Physical Address: r'
Facility Contact: V� �{ al kI, Title: ©knd= Phone No:
Onsite Representative:
Certified Operator: IQ p
Integrator:
Operator Certification Number: 7
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude. [::]o [::]' ❑« Longitude: F]o El' ❑ u
`^ Design Curren Designlolffent
u'
Design Curren#
�Swtne
Capaci Papulatio� Wet Poultry Capacitypulatiou
Cattle Capacity Population
❑ Layer
ElDai Cow
❑ Non -Layer
❑ Dai Calf
s
❑ DairyHeifer
Dry Po_ ultry
El Dry Cow
- '"
ElNon-Dairy
~' ❑ La ers
❑ Non -Layers
❑ Beef Stocker
El Beef Feeder
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Qther
Number of Structures: 3
❑ Wean to Finish
Discharges
Wean to Feeder
7 QQ
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
&Stream Impacts
1.
Is any discharge observed from any part of the operation?
❑Yes
tkNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure [I Application Field El 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
RNO
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
(�.�lo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/28/04
Continued

Facility Number: nq
— Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: c z
Designed Freeboard (in):
Observed Freeboard (in): 33 As-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes R No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? K15 PTYes &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 FK No ❑ NA ❑ NE
maintenance or improvement?
Waste APPReation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S�No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below. []Yes RNo ❑ 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)
5
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation desilm or wettable acre determination?[:] Yes
CRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name ,__TnAN Is Phone:9/n 433-,3"K332
Reviewer/Inspector Signature: Date: Hay
12/28/0 Continued

Facility Number: 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? 1f yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists p ❑ Other
❑ Design ❑ Maps
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 W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 5'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Q NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tRNo
❑ 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
IS 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
JR 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
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Al No
❑ NA
❑ NE
Additional CommBnts and/ror DraWUE S: ` °r `-
Pifte ak ` es -of J,siqod � rnv[ch -o bare s elr 4n La a�.s a43,
�
89 �rnp e- - 1n cover o-, e� 3 0+� lash- a a � ye
5. Sf�S��� a�4 shows 36°�ao/Vez
e"0 1
a!( _ )a cal �9 �o
y s � �
I a.s tKe Ovid o je cotrec�` vP., fe a,QrUsej
r
Leef- tacky o 4 Cow blh6d- 1 JP 14 a im
Nil ma oA4 -evm q- 9ca ree&aJ ouig-0 ((,
Page 3 of 3 12128104

•Facility No. RTFarm Name �¢"' 11V�sg�j 1-3 Date
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design Current FB Drops
-11-Ai !Xa i1/1Q 'th,1Ki
IR • ---
----
bes6n freeboard I---
----
1114served freeboard
a■ 7�---
Sludge S-urvey Date
Sludge •
• . a -
aQsPIM
E
Calibration Date —
Design Flow
Actual Flow
kesign Width
Actual Width
Soil Test Date 0 0A Crop Yield t `--, 120 min Inspections J
pH Fields Wettable Acres Weather Codes s�
Lime Needed —ND - WUP ✓ Transfer Sheets h�
Lime Applied Weekly Freeboard ✓ R6UGAUGE
Cu Zn Rainfall >1" <V4ajd b or incinerator
Needs P 1 in Inspections
ff�1J�
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
_S
13 —
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App, Hardware
FRO or Farm Records
Lagoon #
j
� p
E C6
3
Top Dike
1
) 0 .l
SQ, Co
Stop Pump
s
log
j0,D0
Start Pump

r
®'Division of Water Quality -
Facility Number QQ O Division of Soil and -Water Conservation
Q Other Agency
Type of Visit aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ISRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:® Arrival Time: Departure Time: �, r County: VOLILL Region:
1
Farm Name: l'i 101, iylllj$-W # 1f al, 3 Owner Email:
Owner Name: !&:tnnti rCmiaw Phone: ``,,
Mailing Address: 3 160 PmeshOe yy�� _ d. 1a A Lrp N �_ _ QM6
Physical Address:
Facility Contact: 1(P1117d Title: Phone No: D IQ�- 1303
Onsite Representative: Integrator: srpyn
p K �� p 74h�A o%!�
Certified Operator: I n � W Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o E] u Longitude: =1 ° El I = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
%gamokoo I JE-1 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection Oim
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 59 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JRrNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 a _ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JKNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IgNo ❑ 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? RYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�5No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
D�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
J'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) solb�yh'e�
13. Soil type($) �' $
iv
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
CRNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
tR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
f' No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
IR No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
WNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
Reviewer/Inspector Name U"D Al SCA h e- 'j Phone: —
I
Reviewer/Inspector Signature: Date:
( f 121281041 Continued

IVA
Facility Number: — Date of Inspection l[a2[ld.tvn i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes CK No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tWNo ❑ 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
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CRNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ 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
9"No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CK 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
R-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jjj�No
❑ NA
❑ NE
Additional Comments iand/or'Drawings:
�jaV, 3 hQ.T )e.W-haq 4 been jta�y n-H-�
ch"lcals ae)d ae a1i ono M41Tnfed- +o het f S�Ld`y� i, aoo(?
7. Keep VVa On baese�oh #3) 9cn, rvaljS , �d 0,plc /)ViW env
4- m (chi s�� s w�vPd fat )GU�`,+,ea�J�'� of i d n °tJ° row j ors aG
leap ryak a1 a-�wb�re S 1 on Ja a rnow�o(
a`, CoAn44Cnkr0VTNA(0" r1et&ds-Pof aoo), pleap-hiveaLaiiable- 4neX*
CW.
n
w;1� n�e� ca l i braht�, i � y4+%y►�s aooq
Dt�M I oo ksjooa_
Page 3 of 3 12128104

• Kin IQ W 1ja3
Facility No. pQ"Qq( Time In _ aQ Time Out Date 5 ps
Farm Name Owner
Owner BIMS Address & Phone Cell Phone
Site Rep Integrator Operator S • No. �
Backup No. BIMS OIC No.
COC Circle: General or NPDES (Rainbreaker PLAT Annual Cert )
Pop. Type Design Current Pop. Type Design Current Pop. Type Design Current
Freeboard
1
2
3
4
5
6
7
Design
BIMS
L4
Observed in
Sg
,4
aoD
Sludge Survey DatellAtr Perm Li . ft)
4-No
aD
-314 - 3.7Y J.&r6 a-wy,
Coverage Dt.
Test i�,�,Agoon
I
PH Fields ✓
Lime Needed V0
Cu _�_/ Zn
Wettable Acres
WUP 1: j - 3
Crop Yield
Rain Gauge
Weekly Freeboard
Rainfall >1"
1 in Inspections
4 1 71
3 4
120 min Inspections
Transfer Sheets
Spray/FB Drop
ss- Q0M
s 11_ Dan') I a a I-/
Waste Analysis Date
Pull/Field Soil Crop Pan Window
ri -1
3 p7—'7 U
Yr -T��Dpp%�t_ 53-ft to-40
Ln
(54t h, -� � m mm D . ID
Pull/Field Soil Crop Pan Window
ri -1
3 p7—'7 U
Yr -T��Dpp%�t_ 53-ft to-40
Ln
(54t h, -� � m mm D . ID

FacHity Number
G'D'tvision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit RCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint (Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: BW19KI Region: E
Farm Name: Owner Email:: / l
Owner Name: fl il
Phone: - l O-SI V -1265-
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: n) a
Certified Operator:
Title:
Phone No:
Integrator: 13
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 0 ' longitude: ❑ ° = 4
Design Current . Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Rwean to Feeder 7 8130
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiIts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Currents'
Capacity Population -
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
9kNo
❑ Yes
fgNo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

� r
+ Facility Number — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RrNo ❑ 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): 20,5- C') 01
Observed Freeboard (in): e5i a `S _ ' 3.3 pSj 3 t{
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JRrNo ❑ 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?
KYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA RLNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA F[ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA 19 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA ERNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA CR NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No ❑ NA KNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA ® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA X NE
IComments (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):
e�ve��` add t�la� s V '.3.
tr
Good ob 5oc�cQI On n car" baAk Af I Q'�qqo�,� � eAQTab© s h1f� naf �x tsar' also s' ` or� Si v�si
j 1 � si 9
Cotner o� a o0.1 co bAD/11 t A A� a) So de, co ma neat
s � � s �r ct,d111x mach /1 �
lfvtkrV% �- y ,
A o(,7W-feb on ln51Je bank e 14 oo� re�P l I s{'- hl h to laces �4f) s
Reviewer/Inspector Name p� 'Phone: lq l o�l
Reviewer/Inspector Signatur Date: COO (4333
12128104 Continued

r
Facility Number: t) 1 —6 1 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA )0 NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA RNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 5a E
❑ 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
❑ No
❑ NA
DjrNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
9NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
5j�NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
Pd'NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
jffNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
qNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
WNE
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
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
j2rNE
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
IWNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
`gj E
Additional Comments and/or Drawings:
12128104

Facility Number
Division of Water Quality
Q Division of Soil and Water Conservation �y
O Other Agency
Type of Visit Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'i7 Arrival Time: Departure Time: ! ,370County: Region: "
Farm Name: '+ n La u1 ur I_ip eg � Owner Email:
Owner Name: _ ��, in i rL id! Phone:
Mailing Address:
Physical Address:
Facility Contact: kn ri emu/ Title:
Onsite Representative: _5elz�__ _
Certified Operator: _ S
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Phone No:
Integrator: _�w
Operator Certification Number:
Back-up Certification Number:
0„ Longitude: [�° =, [„
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
D O0 ❑Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Currents
Capacity Population-"
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
s
-I
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
12128104 Continued

`
Facility Number: —
Date of Inspection FH�7
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C,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
S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): p70 8 - __c9O. 5-
Observed Freeboard (in): 13 39 '1 15_�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo ❑ 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
IR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo ❑ 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) ; ,- Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[8 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®No
❑ NA
❑ NE
to'. gue,
ReviewerlInspector Name I =ei%
ReviewerlInspector Signature: Date: Lf—�j 2
12128104 Continued

.
Facility Number: — 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 KNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Off No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
El Yes
[4No
[I NA
❑NE
❑ Yes
9) No
❑ NA
❑ NE
❑ Yes
(g No
❑ NA
❑ NE
❑ Yes
C9 No
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
KYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
J �
rot m.S pvL 71� c 14JA �_Z -j-v ,5k tJ7,r Vq:3
K_'V_ yovr- '2-�f
05) a rM'I v". u f ►1 e � r6� a) rwtr Cfi-;,,-a'---
12128104

e
Type of Visit O Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit l-7 outine O complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: /05:7 ` Arrival
711-0-e9l
Departure Time:
County:
Name: �I7
//Timed
/"Gcr�/
3 Y4�
ij,q�Farm
Owner Email:
nwnor NInmt-!\YI7N
f
T� f 12- �6te.tJ
PhnnP-
Mailing Address:
Physical Address:
Facility Contact: cK j1A !� v1 L.00J Title: Phone No:
Onsite Representative:._ _�-� Integrator: Iit�_
Certified Operator: S�'^-�— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region: lC/;i�70
Location of Farm: Latitude: 1--] o = I ="
Longitude: =1 ° = I = u
ign Current
FRacity Population
DesigurrentMU_ClugrenSwine0
Wet Poultry Capacity Population Cattle Capacity opulation
❑ Wean to Finish
❑ La er
Dai Cow
® Wean to Feeder
O
77DO
❑ Non -La er4
FE313airy Calf ITJ
❑ Feederto Finish
❑ Farrow to Wean`
❑ Farrow to Feeder
El Farrow to Finish
Gilts
P10:1 Boars
D'
Dry�Poultry
❑ Layers
Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Non -Layers
El Pullets
❑ Turkeys
other
❑ Other
❑ Turkey Pouets
10 Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
IgNO
❑ NA
❑ N>
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[--]Yes
X) 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
allo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
jq No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
X No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —
/O-/p-�!a
Date of Inspection
Waste Collection & Treatment
r--
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1 _ p?y�-
Observed Freeboard (in): J�7 .3,5 - ��-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes DgNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Cg No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JKNo
❑ 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
EgNo
❑ 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.
E3 Yes
he-
n—4lo
❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Window
Crop h'pe(s) S�i�ux s ?V"/��
13.
Soil type(s) 1�hf�-o
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
W 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
JR1 No
❑ NA ❑ NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA ❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C9 I KIT ervpr; 0 yl�qr
Reviewer/Inspector Name d �,�- Phone: _9`j&-
Reviewer/Inspector Signature: Date: /O /'9
rage -, of -1 I1%18/U4 c,onanuea

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rgNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checkiists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 19 Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 64Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ 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
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
13No
❑ 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
EgNo
❑ 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
14 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
P9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments 'and/or Drawings:
Page 3 of 3 12128104

w
Type of Visit compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
1 i;L_
Farm Name: 1!Ci JIII/ j)fAfS4L `Owner Email:
Owner Name: ti�It_m k -,n_L .: yJ Phone: L&
Physical Address:
Facility Contact: ,5rw, ___ Title:
Onsite Representative: _12 Y
Certified Operator: -5'r on yt
Back-up Operator:
Phone No:
Integrator 1
Operator Certification Number: •i,2loLl
Back-up Certification Number:
Location of Farm: Latitude: [::] n 0 1 = 11 Longitude: 0 ° =1 =1 11
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity .Population _ Cattle Capacity Population
❑ Wean to Finish
193"Wean to Feeder Q 1sQQ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
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 4 No ❑ NA ❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
]] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PtNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
12128104 Continued

Facility Number:0 —
Date of Inspection -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KA No El NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
fA No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
T'-
Designed Freeboard (in): �� % P7 c
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
14 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
Z 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?
JVYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[K 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
V,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
(ZNo ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Dare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) f��,( zC22
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[VNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
EZ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
X No
❑ NA
❑ NE
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
JK No
❑ NA
❑ NE
I'l.(L u
`L t'GO' cz : rz �T'o'l d�v1 C G B
T!1
S f v� tic /V r Ta �4 IC
17'p11s-e- , y0
`T-0 St— r j /ru S S O-n �-—
~tic
A- ✓Y e,_ ,
ReviewerlIns ector Name Phone:!rl
P Reviewer/Inspector Signature: Date:
101, 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CS No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JKYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis tO 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 J@ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
_—aw-
24. Did the facility fail to calibrate waste application equipment as required by the permit? V Yes Q No ❑ NA ❑ NE
S
25. Did the facility fail to conduct a sludge survey as required by the permit? Yes El No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? WYes ❑ No [KNNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWM P? ❑ Yes E4 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
4No
❑ 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
CQ 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
CR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
El NE
Ad[lrtrizoal Coiiiments and/or Drawings`,
..
Shea �,pl Del v� o �5
�I� fln /f%OS�7�rG,er,S iti~� �vGU
12128104

_ � Division of Water Quality a 3 f0 % r
,Facility Nu>�Iber-- Q Division of Soil and Water Eonservation
� Other Agency � S7�
Type of Visit ID Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 49 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Time: + Departure Time: County: 431,r A J Region: FIC 0
Farm Name: _ K i r1 jfaU2 /VSA do r_T #a�, Owner Email:
Owner Name: _ Aciczdca��. ,.... K; n l a iv Phone: C2 1 1 - `J.9I4,
Mailing Address: 316 0 14o,--scskoz_ LC_nQ___-_--- Qisd1-wcto+-tomy itC 4,3aC.
Physical Address: S a V- c cis G o v
Facility Contact: �< ur.► c+t, 14, ti- ew Title: e) C., „ c IC Phone No: C ! t{� qplG
Onsite Representative: Integrator: r-y) S& -ion. i4-
Certified Operator: i a&" c ._t4, I� i h , e w 3 ►e - Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = = = Longitude: [__1 o [__1 1 1
1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
'7 ydv 1� ❑ Non -La ei
h _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Co Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? ([f 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
50 No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
Q
b
❑ Yes
❑ No
VNA
❑ NE
❑ Yes
El NA
DO NE
❑ Yes
r❑-,/No
ua No
❑ NA
❑ NE
12128104 Continued

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9% 0 Departure Time: County: jeto ee au Region: F�Po
Farm Name: k; k IOU-0 /Vu Ps,-�
// 3_ Owner Email:
/l Owner Name: _ cAiAf4f 74 �i n 1 0 +" Phone: �S U)
Mailing Address: 3 .� d / �� r� c x a 15.� _ — Q o �� k h .-u I\f C-
Physical Address: S o c Ck s G o v
Facility Contact: �� c �� ��, ti cw Title: n c-, r. L, - Phone No:
Onsite Representative: Integrator: 0_2 +.- 24 14—� r czia,t n4r
Certified Operator: 9e_N" r,4 _ G . V I * low ie Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e =' = « Longitude: = ° =' ❑
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish #
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
I
::::::i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ 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?
Q0 Yes ❑ No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
�] Yes
❑ No
❑ NA
❑ NE
tlllb
❑ Yes
❑ No
O/NA
❑ NE
[:]Yes
❑ No
❑ NA
�fl NE
❑ Yes
® No
❑ NA
❑ NE
12178104 Continued

Facility Number: 9- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No [20 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 ❑ No ❑ NA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ® NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA [XI 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 El Yes ❑ No ❑ NA ®NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA W NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus []Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
EN 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
5a NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
V] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
P NE
Q r
13 j 0s 7" 1. c -{ ' n. w G
v Z s ► t-��C a a f �. -E- o-t�
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+hL � �t�d` Q.r�q'` �►�..�Cr'�'i�j
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t�-.� 'tow c]� �c;Sfc� r►'lr_ , jaw ca�sra',���
f�-� Wes-c
Re0ewer/Inspector Name °L-ar,. ! a co, M"ma Phone: )0 - al Sri
Reviewer/Inspector Signature: Date: 1113 0--'r
14 12128104 Continued

Facility Number: 9 — G Date of Inspection / /3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA a NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 00 NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA T NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA P 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
Q 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
Ep NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
IM NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
[50 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
T 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
50 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DdNo
❑ NA
RI NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
F� NE
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12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit , Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: 1 0 Tune:
Facility Number
- _�... O Not Operational. Q Below Threshold
Permitted %Certiffied `` 0 Ova
Certified [3 Registered Date �t Operated or Above Threshold:
Farm Name: . 4_1.r41�t� . _ N t3 r5 et �1--- - Z .. .�._. _ Coanty: _. I�1... ... » ... _
Owner Name: _ Vk„CAL-= _. + Kin 1 'Phone No: -� ?
Mailing Address: .._ 31 (d o- r,Rti r-sQ 6 6 e_ ?4. 91m6ot e..�La" .. 2 _. u 5-2b
Facility Contact: �� w�a11'^��^� Title: Phone No:
Onsite Representative: � � �' 1G�: a L a 62 Integrator -
Certified Operator:Ke+�+'Le _.. Lam! ------ Operator Certification Number _Aata—
Location of Farm:
1,w
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• Du
DesiF
C.mri�eat s Current Dew -Current
Swine6oa. p9: PoLL 'aa. "CaffiePo on
Wean to Feeder Layer Dairy
Feeder to Finish , k Non -Layer Non -Dairy
-
Farrow to Wean ms
Farrow to Feeder Other
Farrow to Finish Total
Gilts. � S 00
Fi
Boats
N4mb6r 1ii. OQd15T <
iTi charges & Stream acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes WNo
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes allo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .51No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JkNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches):~ v
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed thorough a waste management or ❑ Yes 5KNo
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;KNo
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes RNo
9. Do any stuctums lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes RNO
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/unprovement? ❑ Yes O(No
I 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes C&No
❑ Excessive Ponndingll ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. C-ep ripe-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ER No
b) Does the facility need a wettable acre determination? ❑ Yes [W No
c) Ibs facility is pended for a wettable acre determination? ❑ Yes [RNo
15. Does the receiving crop need improvement? ❑ Yes EkNo
16. Is there a lack of adequate waste application equipment? ❑ Yes M�No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �No
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
2 . TI�� wo-5 a. f wv�o (0-4-- 6QA"-"- t'Anr�f- -sk 3 "e ct- SP; Lt
O GG1Jr r-eA
? ,io,i`(. A4r. /C.k (a.w w; It ater>+ �a1 Q 6 a-� 7 s� ' -t- e fT
Reviewer/Inspector Name
Reviewer/Inspector Signature:
» VIIA2
Date:

Facility Number: ? _ & i I Date of Inspection 11
Required Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ANo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.)
5[Yes
❑ No
23. Does record keeping need improvement? If yes, check the priate box below.
$' Yes
WNO
Waste Applicati�❑ FreeboaA RWaste Analysif ❑ Soil Samplinko'---
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Flo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZNo
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
J.No
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewerllnspector fail to discuss review/mspection with on -site representative?
❑ Yes
KNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of -the Certified AWMP?
❑ Yes
❑ No
N! MFS Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
JANo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDFS inquired forms need in4mvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Foam ❑ ❑ Inspection After I" Rain
❑ I20 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this vL%L
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12112103

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint • Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number lv
Date of visit: 1 g!a Tune: I % ob
0 Not 0rational 0 Below Threshold
Wermitted SCer lied 13 Conditionally Certified 0 Registpered Date -fit Operated or Above Threshold:
Farm Name: _—! t6L.2 _!" v t #L J County: ». 964-11
Owner Name: ,,,,.— �.i V.-i — _, Phone No:
Tailing Address:.. 3) jo _ _
Z-8.3 20
Facility Contact: �J� -+�� --------4-- - -- ---- Mille: Phone No:
Onsite Representative:. . �-4^ +�` ` ts-.�] _ . _ Integrator- — W���
Certified Operator:. e N _ .. Operator Certification Number: �o
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 69 Longitude •
:Destgre C'n>irr,
xt =Design =- Des�n Crrnt-. Cmt`
P-
o'aSwine Cca . Po Maton
Wean to Feeder - Layer Dairy
Feeder to Finish = Non -Layer Non -Dairy
Farrow to Wean -
Farrow to Feeder Other
Farrow to Finish -Tow
ty
Gilts w
Boars T©W SSLW
Dlschar% &StreamImpacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'.? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ yes ❑ Na
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

FacilityNumber: — & ( Date of Inspection [ Z 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Up.
se wines',
to betterexplatn es sttaatwas. {ose adcLfaoaal pagasnry)jT3 Feld Copy ❑ Final Notes
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ReviewerAnspector Name
Reviewer/inspector Signature:
ite: d
Continued
12112103

„JAMZS B. FiuNTlf
'�v
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
FAYETTEVILLE REGIONAL OFFICE
DIVISION OF WATER QUALITY
June 24,1999
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Kenneth IGnlaw
3160 Horseshoe Road
Bladenboro, NC 28320
SUBJECT: NOTICE OF DEFICIENCY
Kin law Farm #1 - #3 and Kinlaw #4
Facility Nos. 09-61 and 09-148
Bladen County
Dear Mr. Kimlaw:
On June 3,1999, staff from the Fayetteville Regional Office of the Division of Water
Quardy conducted routine inspections on your swine facilities located in 6laden County. It
was noted that lagoon #3 failed to have a suitable grass cover on portions of the inside
slopes. A review of the irrigation records indicated that the correct Plant Available Nitrogen
(PAN) rates for each crop were not being used as specified in the Certified Animal Waste
Management Plan (CAWMP). Irrigation records also indicated that only one waste sample
was taken on the farms in 1998. It is a requirement of the General Permit along with the
CAWMP that an analysis of waste shall be conducted as close to the time of application as
practical but at least within 60 days (before or after) of the date of application.
The Division of Water Quality requests that the following items be performed:
1. Continue efforts on establishing a suitable grass cover on the inside slopes of lagoon #3
in order to prevent erosion.
2. Immediately begin using the PAN rates foreach crop as specified in the CAWMP in order
to prevent over application of nitrogen to the crops. Also need to use a separate IRR-2 form
for each crop each year.
3. Take a waste sample as close to the date of application as practical but at least 60 days
before or 60 days after application as required by General Permit condition 111.4 and the
CAWMP.
225 GREEN STREET, SUITE 714, FAYETTEVILLE, NORTH CAROLINA 28301-5043
PHONE 010-"6-1541 FAX P1 O-466-0707
AN EQUAL OPPORTUNITY IAPPIRMATIVE ACTION EMPLOYER - 504E RECYCLE0/10% POST -CONSUMER PAPER

•
Page 2
Kinlaw Farms
June 24,1999
4. 1 have attached two integrator registration cards to this letter. i checked the appropriate boxes that pertain
to your farms. Please complete the top and bottom portions.of the cards and mail. The postage has been
prepaid for your convenience.
Please notify this office in writing on or before July 23,1999 at the letterhead above as to the actions
taken or proposed to be taken to resolve these deficiencies. Nothing in this letter should be taken as absolving
this facility of the responsibility and liability of any violations that have or may result from these deficiencies.
If you have any questions concerning this matter, please do not hesitate to contact myself at [phone].
Sincerely,
Jeffery Brown
Environmental Engineer
cc: Sonya Avant - Compliance Group
Sam Warren - Bladen Co. NRCS
Audrey Oxendine - DSWC Fayetteville Office
Central Files - Raleigh
Jimmy Vinson - Brown's of Carolina, Inc.