090078_INSPECTIONS_20171231

0
Type of Visit: fD—Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance l
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: 077--_171 Arrival Time: 'P Departure Time: County: Region: F-)iz Z)
Farm Name:
Owner Name: Lief
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: o
Certified Operator: 41-ft y Certification Number: /b;x2M
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
IDairy
Cow
Wean to Feeder
I iNon-L!Xer
I
ai Calf
Feeder to Finish
a
Daig Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ,P,oultr.
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Puults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Eallo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2-No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �� l
Observed Freeboard (in): l�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3-&o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [3"�o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q 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 PI'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2-'Ko ❑ 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 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 []1C ❑ 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 Q o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D'1Go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-lo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑i "No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

�7
.]Facility Number: - Date of Inspection: 'r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'Ilo ❑ NA ❑ NE'
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EJ-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes G3-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [JNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
La"go
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
El'No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3 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 Q No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes [3No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3 1VO ❑ NA ❑ NE
n yoVr-7"__e&0gb
�v ��'L ��c� Sv✓ti F�1r 17 0"9--
Reviewer/Inspector Name: �� �-t.,,/�—� Phone: :3�3 f J
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit t9,Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 01 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .� O Departure Time: County: Region:
Farm Name: -n� Owner Email:
Owner Name: t% car- r)— Dr Lln e, 4u-�r% Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�+?17 T Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: De L m a-s- A Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I =" Longitude: = ° =,
= "
Design CurrentiBoars
WEPolu'rr"
ne n
Wet Poultry
Capacity Population
Cattle Capacity Population
Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
❑Non -Layer
❑Dai Calf
ER Feeder to Finish (o (� �%
DairyHeifer
Farrow to Wean
Dry Poultry
§
❑ D Cow
Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ Layers
❑ Beef Stacker
Gilts
❑Non -La ers❑
❑ BeeF Feeder
Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Pq No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page l of
12128104
Continued

Facility Number: - Date of Inspection - %D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes f �No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
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
[KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
RSNo ❑ 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
[RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ff�NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop typc(s) 3 eCW 9L 1 !�s!✓S Pr���Ci.( Lv lG� LW)W��s®lbY.^�s
% L
13. Soil type(s)
® i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
29 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question #t): Explain anyYES? 'answers and/or any recommendations or any€other camnients ': } Use drawings of facility to better explain situations: (use additional pages as necessary):
Ce-),Tr-�L
Reviewer/Inspector Name- ��
- Phone:
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents ,�!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes , Rio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [T No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 23-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
[&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
JgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
April 11, 2006
MR. OSCAR L. AUTRY APR 12 2006
OSCAR AUTRY FARM
489 MCLEAN ROAD
ELIZABETHTowN, NC 28337 pH6i—FAyEIT 1IJ.EAE41flNA1.
Subject: Phosphorus Loss Assessment Tool
Oscar Autry Farm
Permit Number NCA209078
Bladen County
Dear Mr. Autry:
The Division's records show that a completed PLAT Form has NOT been submitted for this facility. An
extension from the due date of October 6, 2005 was requested however the time allowed by the extension has
expired. if our records are in error please resubmit the completed PLAT Form for this farm. If the PLAT Form
has not been submitted, please do so by May 15, 2006.
Condition I.6 of your NPDES Permit states: "If prior to the expiration date of this permit either the state or
federal government establishes Phosphorus loss standards that are applicable to land application activities at a
facility operating under this permit, the Permittee must conduct an evaluation of the facility and its CAWMP
under the requirements of the Phosphorus loss standards to determine the facility's ability to comply with the
standards. This evaluation must be documented on forrns supplied or approved by the Division and must be
submitted to the Division. This evaluation must be completed by existing facilities within six (6) months of
receiving notification from the Division.
The method of evaluation is the Phosphorous Loss Assessment Tool (PLAT) developed by NC State University
and the Natural Resources Conservation Service. PLAT addresses four potential loss pathways: leaching,
erosion, runoff and direct movement of waste over the surface. Each field must be individually evaluated and
rated as either low, medium, high or very high according to its Phosphorus loss potential. The ratings for your
farm must be reported to DWQ using the attached certification form. The PLAT forms must be kept as records
on your farm for future reference.
Please be advised that this notice does not prevent the Division of Water Quality from taking enforcement
actions for any past or future violation. Furthermore, the Division of Water Quality has the authority to levy a
civil penalty of not more than $25,000.00 per day per violation.
If you have any questions regarding this request, please do not hesitate to contact Duane Leith at [phone]
or contact the Fayetteville Regional Office at [phone]. Thank you for your cooperation.
Sincerely,
Duane Leith
Animal Feeding Operations Unit
cc: +Fayetteville Regional -Off ce A P S
Facility File 9-78
Aquifer Protection Section 1036 Mail Service Center
Intemet: www.newatmuality.0g Location: 2728 Capital Boulevard
An Equal OpportunitylAifirmatNe Action Employer— 50% Recycled110% Post Consumer Paper
N�am�`ltCarolina
watura!!f
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

f
Type of Visit bca'mpliance 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: 149 ` -5_ Arrival Time: , flx? Departure Time: / a : [7 County: r" t- Region: PIK
Farm Name: _(915e0 rOwner Email:
Owner Name: n,5c, v— rL D�� G� / rY Phone:
Mailing Address:�1l�.-�
Phvsical Address:_
Facility Contact: /`Y/J�'!� _ s��r' Title: Phone No:
Onsite Representative: �_ Integrator: �d/6,d+:�I�it►i Ssrr�l
Certified Operator: ��L r�7G _____ e.(�✓ y Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o [= s = Longitude: 0 ° 01
s :. 'Design Current Design Current
Swine `'Capacity Population Wet.Poultry Capacity Population
- ❑ Wean to Finish ❑ Layer -
Wean to Feeder ❑ Non -La et
IS Feeder to Finish Oo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discbarj!es & 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 Curreni
Cattle Capacity Populatia
❑ Dairy Cow
I
1H
❑ 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?
0
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
rn No
LA
❑ NA
❑ NE
❑ Yes
f g] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[gNo
❑ 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
La No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
J4 No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in): f�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Na
�
El NA NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
� No
❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
QQ 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
VQ No
❑ NA ❑ NE
maintenance/improvement?
11. 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 l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s)zkm�I;C.2I'
13. Soil type(s) . — �r r34 pt� �t%��'� �z�ar •�
—_
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?
ryes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
QQ No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
M No
ElNA [INE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA ❑ NE
edllkJ�sos74,
Reviewer/Ins ector Name F r Ffi
p -v�� .1'�; .rPhone:
Reviewer/Inspector Signature: Date:
12128104 Continued

4
Facility Number: —' Date of Inspection apt S—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9LNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste "Transfers nual 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
E&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
� No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
!KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
El 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
§qNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J@ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
12128104

Facility Number 7 g Date of Visit: y o Time: I Y s
O Not rational 0 Below Threshold
Ogermitted Q Certified 0 Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
Farm Name: Dcg �. - F....._ aA._ _ Ww_. County: �___....
Owner Name _ � s,c_._.�t.^ . Q g .. _1? y r _.. Phone No: "..588' .`� �. 6 .._._
_V. a hng Address: s-- eQ. �t ._ El zade7 7�e...�t• NC ?8 33`L_._N _ . ....
Facility Contact: _ ae/mdL Phone No:
Onsite Representative: Oe�a A�f, �Q r,� C� Integrator•. 6&-&ffcZ &rnm__S&:_444. _•.,
Certified Operator. _ De%r, - - ►. Operator Certification Number: - /6.72 r7 _
Location of Farm:
[Swine ❑ Poultry [3 Cattle ❑ Horse Latitude �• �< ��' Longitude F �`
Discitarees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes MX6'"
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 00
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ag
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 13fio
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
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 Rio
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Condaued

Facility Number: &7 — 7 y I Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[des
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
,
(eel i'ts, de op, Wapiretc.)
EINO
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M44o
❑�—❑ WaVA g
-3I-> f,2.�Z
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
BNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
elgo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[:]Yes
allo
28. Does facility require a follow-up visit by same agency?
❑ Yes
0"'0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O o
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (if no, skip questions 31-35) &1res ❑ No
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M-W -
32. Did the facility fait to install and maintain a rain gauge? ❑ Yes ❑-Ne
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 0"lTo-
34. Did the facility fail to calibrate waste application equipment? ❑ Yes &M
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below. Uj*es ❑ No
op Yield Form » ❑
❑.lager Tn� s ❑
I2/1V03

acdity Number: q —
Date of Inspection I 11-�>
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
R<O
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
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
two
S. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
2 iqo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
2NO
elevation markings?
Waste AAplication
10. Are there any buffers that need maintenancelrmprovement?
❑ Yes
UKO
11. Is there evidence of over application? if yes, check the appropriate box below.
❑ Yes
Milo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �i.., ..�a 5.,,.✓/ Goa.:, a �.r�srr,1/, Fes e-"� . C...,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW?")?
❑ Yes
EQo
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
9090
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 0-60
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0-90
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 0440
Air Quality representative immediately.
Find Notes
Reviewer/inspector Name/1=;��wit:—
Reviewer/hupector Signature: -�,4 -_ -_ Date: - -o
12/I2103 Congnrreid

(Type of Visit: ®'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (—A'Ro%'tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I !J�- Arrival Time: I q, ', O a Departure Time: County: Region: C�
Farm Name: a / ai-
Owner Name: 0e, C-f
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: rti ve r Title: J�,, Ir-e- Phone:
Onsite Representative: Integrator: �L�'��✓.45�jj��-
Certified Operator: Certification Number: & �Zp
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
Dai Cow
Wean to Feeder
Non -La er Dai Calf
#
Feeder to Finish
Farrow to Wean
a#
airyHeifer
Design Cu"r'rent D Cow
Farrow to Feeder
D . P,oul Ca aci Pe . Non -Dairy
Farrow to Finish
La ers Beef Stocker
Non -La ers {'. Beef Feeder
Gilts
Boars
Pullets Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1 _ is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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
g No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ® No
[] Yes RINo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: -Z Q
jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
S pi I I way?:
Designed Freeboard (in):
Observed Freeboard (in): -z 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;EkNo ❑ 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
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LKNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fo 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):Lr-
13, Soil Type(s): r Z AD
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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
EINo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ 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
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tS No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Og No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gallo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
jo No
❑ NA
❑ NE
❑ Yes
JQ No
❑ NA
❑ NE
❑ Yes
J] No
❑ NA
❑ NE
❑ Yes J4 No ❑ NA ❑ NE
[—]Yes NINo ❑ NA ❑ NE
❑ Yes W_No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes jg No
❑ Yes M-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name:Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

IV
Gr
tvision of Water Resources
Macifilumber l� - O Division of Soil and Water Conservation
O Tf Jther Agency
Type of visit: om�pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
O Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: —� JL Arrival Time:j Departure Time: /; 9 County? Region: �C(7
Farm Name: f ISGQ _�1 U / y �Q/ Owner Email:
Owner Name: /JsCa,r_� �`G(7�r7 Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: /1�r _ Phone:
Onsite Representative: J �� _ Integrator:
Certified Operator: �y�rr�Cc �, � y _ Certification Number: 11a D
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish (o I)
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P,oul Ea acit P,o .
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
urke s
urke Poults
4()
er ther
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 gLNo ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,Eg No
[::]Yes allo
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
— /(a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FZ-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):_ J
Observed Freeboard (in): 7�
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
ff No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift /❑ Application Outside of Approved Area
12. Crop Type(s ): az�/i17��i�� �dv ��s �a� Corn �/•c�h •�. J� f�5 �-���
l3. Soil Type(s):42 Gy f�
�Dea/�
1W _
l4. Do the receiving crops differ from those designated in the CAWMP? 0 Yes [. No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® 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?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes R No
❑ Yes [ANo
❑ Yes E� No
❑ Yes fa No
❑ NA ❑ NE
�]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ 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

M
Facility Number: - Date of Inspection: 7?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _Z] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fa 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 [A -No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to property 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes B No [DNA [_]NE.
❑ Yes [2FNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes jjq No
[:]Yes allo
❑ Yes ELNo
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
Phone:
Date:
21412015

/';�?- ► o - 1s
(Type of Visit: ('Compliance inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: F-itoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: U -9—I Arrival Time: / ; o 0-1 Departure Time: p v County: „G, ,s._ Region:
Farm Name: 05c - Atx =
Owner Name: n!5
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: ^_ a
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: ���e __-2—
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da Calf
]Feeder to Finish �
Da' Hcifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P,oult .
Layers
Ca aci
$o
Non -Dairy
ow to Finish
Beef Stocker
s
Non -La ers
Beef Feeder
rs
Pullets
BeefBroodCowTurke
k
s
er
Turke Poults
er
Other
Discharges and Stream Imnacts
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 ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 17-7 Ds ection:S-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes DSNo
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): — lg
Observed Freeboard (in): f L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [g 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 [Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7_ Do any of the structures need maintenance or improvement? ❑ Yes allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [A No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [a No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo
❑ Yes [ANo
[] Yes No
❑ Yes No
❑ Yes [ No
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑ 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 F_v1 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�J'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: p .-
::f—
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes]
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
L010-
❑ Yes 21 No ❑ NA ❑ NE
[:]Yes Jallo ❑ NA ❑ NE
❑ Yes ® No
[:)Yes [R No
❑ Yes P3-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
and/or any additional recomntendstionsfor any other comments
Use dra*mgs of facrlity to better a plarn situations(u a ad, i ' , . i .. ak
- -
diteonal pages as necessary)`'x
U
Reviewer/Inspector Name
Phone:33bc:>
Reviewer/Inspector Signature: Date: _c9
Page 3 of 3 214,12014

Type of Visit: UCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: tloutine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit:_J` Arrival Time: ; pii:i Departure Time: ', p County: Region:
Farm Name: Owner Email:
Owner Name: r-L�]��-y Phone:
Mailing Address:
Physical Address:
Facility Contact: r, L Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �Yr-lrna Cy Certification Number: ZG22D
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design; Current
:.
Capacity , Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Ca#tle Capacity Pop.
Wean to Finish
La er
f
DairyCow
Da' Calf
Wean to Feeder
10ther
Non -La er
D . P,oul
Layers
Non -Layers
Pullets
Turke s
Turke Poults
Design
Ca aei
-
Currrent
lop-
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Gilts
Beef Stocker
Beef Feeder
Boars
Beef Brood Cow
�.
_.
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
HNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFaciHty Number: - Date of Inspection:
ZR
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5A No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CF�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
R1 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
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
21 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2-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):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check
❑ Yes
[&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [-]Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [A No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E[ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E� No ❑ NA ❑ NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes o ' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Sion -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: A 4Z — d`-ff f
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 0No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 54 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes 5D No [ ] NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes E4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Expl4n any YES: answers and/or any additional recommendations or any other comments.
Use dravwings of facility ta.better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

0
Type of Visit: UComp . ace Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral Q Emereencv O Other O Denied Access
Date of Visit: Arrival Time: ; p,p Departure Time: ; 3 County: .--- Region: IFE-C—)
Farm Name: _'aaaL u y f:f'aea - Owner Email:
Owner Name: &eaQr i- �-i � �`(y Phone:
Mailing Address:
Physical Address:
Facility Contact: -�'i-y Title:
Onsite Representative:
Certified Operator:; a- i ,�•-- /4 �c�,-y
Back-up Operator:
Phone:
Integrator: �el,+l FGtrn�
Certification Number: 9'9-�a 4, 152-
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Ca aci
p ty
Po P
Wet Poult .
ry
Ca a_ciPo
p h D.
Cattle Ca aci Po
P tv p•
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish f�
r
Dairy Heifer
Farrow to Wean
.
Desir
Dry Cow
Farrow to Feeder
D , Poul
Ca aci
1'0
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
allo
❑ 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
`Z-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E[No
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
1 q
Designed Freeboard (in): I I
Observed Freeboard (in):
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
® 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
C.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 Aapiication
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 n 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) ���n , fit'/ /s Or' r� /�c/ tc�C� / 4!5 Y
13. Soil Type(s): C / a `
a ✓
14. Do the receiving crops iffer from those designated in the CAWMP?
❑ Yes
®-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�j 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
® 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 M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

l aciliNumber: jDate of Inspection: El
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0—Yes ❑ NA ❑ NE
the appropriate box(es) below. 7io �
❑ 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: z-- /
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [a No D NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes 0,No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes EZ No
❑ Yes J�DNo
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
Comments (ref&%to question #): Explain any YES answers and/or any additional recommendations or any other comments "
Use'drawin�s.o(facthtvto better explain situations (use additional 0a6s as necessary).
r
a�Gk. ��Pa r` L i✓a d- lz- Ce v'-r -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:f)
Date: //—/ —%�
21412011

Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:—/ Arrival Time: : D J Departure Time: / ; a County: Region:
Farm Name: P::,:, Owner Email:
Owner Name: ���� L 7�yt'-f7`y Phone:
Mailing Address: �T
Physical Address:
Facility Contact: h—_rn ►I y I`y Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Desi u Current
Design
Current
Design Current
3wme .
Ca a�
e� Po
P h P
Wet Po tr.
Capacity
Pop
Cattle Gagacity Pog.
Wean to Finish
La er
Da'x Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
fdo
-
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poultr
Ca aci
P,oP
on-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [:]No
❑ Yes ❑-No
[:]Yes B No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number: - Date of Inspection: 6/J--k;;V121
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2�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
EJ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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 ❑ Appliccation Outside of Approved Area
12. Crop Type(s): ea
% l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3.-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes QNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
E� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�_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 QqNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA] NE
[] NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z .No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes allo
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 Callo ❑ NA ❑ NE
[:]Yes ELNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [R No
❑ Yes [allo
[:]Yes Ea No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any,YE5 answers and/or .any additsonal recommendations or anyrother comments
Use drawings of facifl to.better ex lain situahons: use additional: a es as nece_ ` "`�� "�'
,,
g h' p P P ssary)•�
it._ . z �F7.., ._. .ter tr'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /) o `4153 33cyc:�'
Date: 1 ` /
21412011

(Type of Visit: UCom iance Inspection O Operation Review (] Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: a-/ Arrival Time: b Departure Time: _ C> County:
Farm Name: -/ !--aArr`-' Owner Email:
Owner Name: S r Phone:
Mailing Address:
Physical Address:
Facility Contact: '6 nXE6d An5&Title:
Onsite Representative:
Certified Operator: a
1*7
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number: 22 _
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PoultryCapacity
Pop.
Cattle Capacity Pop.
11111111
Wean to Finish
Layer
IDairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C*urrent
Dry Cow
Farrow to Feeder
D . P,©ultr -a aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Layers
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
[,;k[No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facili Number: Date of Inspection:
D-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /(
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
,A 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
2-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, setbacks, or compliance alternatives that need
[]Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
VLNo
❑ 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 Approved Area
Window
12. Type(s): 0�� 11 ��Ss� j �i��G�(�/3
1
Crop U1� r ��yyt�C.�
�-r� r✓5�
13. Soil Type(s): Q �� �_p G��✓
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3-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
R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
54 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
(�j 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
�4 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
to No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
59-No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes f4 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[..Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
'
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0,No]
NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
0
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
" 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
KNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
r No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5�-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:
Date: 6
21412011

Type of Visit 0$'Compliance Inspection O operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit AQ'Woutine O Complaint O Follow up O Referral O Emergency O other ❑ Denied Access
Date of Visit: /� D Arrival Time: 0 l) Departure Time: County: r"�- Region:F 7K D
Farm Name: Owner Email:
Owner Name: & il"n /" L_ _4 Phone:
Mailing Address:
Physical Address:
Facility Contact: .62- nn ,— Title:
Onsite Representative:
Certified Operator: -
Back -up Operator:
Phone No:
Integrator• 4g "_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = u = 4 0" Longitude: = ° = I = "
Design Current
Design
Current
Design Current
Swine Capacity Population
Wet Poultry Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
ElDai Calf
Feeder to Finish 1fO 111glep
❑ Dairy Heifer
❑ Farrow to Wean
Dry Paultty
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets lets
ElBeef Brood Co
❑ Turkeys
Other
❑ Other
E] urkey Poults
El Other
Number of Structures:
Discharges & Stream Impacts
I- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

~ Facility Number: Date of Inspection /!]
= Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JE9No ❑ 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): 3 D .3 [7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 OgNo ❑ 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 2.No [:1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5ANo ❑ NA ❑ NE
maintenance/improvement?
]I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Uff-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)x'/y—_f�v��
13.
Soil type(s) �� i• l /,Uzz �,r y-, T ��u� 7,- %e—
--
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Ycs
O No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5INo
❑ NA
❑ NE
Comments (refer to.quest�on'#): Ezplatn?aiay YES�a e s andlor any recommendations o any ether comments-
Use drawings of facility to better explain situattons (use addthonal pages as necessary)
qV
._
ReviewerlInspector Name ,..= fir.: ��x , j�+, �� Phone: /a
Reviewer/Inspector Signature: Date: t7
Page 2 of J «��

Facility Number: g— Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9!�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropriate box. ❑ W"Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ 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
U.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B No
❑ 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
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C 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
[9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

H M.S y l as t o
Type of Visit P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �5 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �y Arrival Time: �Oe Departure Time: County: Region:
Farm Name: osc&` ALltfx Falb Owner Email:
Owner Name: CJs Qr Azt-v Phone:
Mailing Address:
Physical Address:
Facility Contact: _ eigo f±3 AvI ru Title: MGCIQ A P/' Phone No:l --701 3 L—. 3 30
Onsite Representative: Integrator: C-4 I& _
Certified Operator: O- AV Operator Certification Number: 1070
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o = , =
IrI
Design Current" F
Design Carreut
Design Current
=Swine
-f _..F
Capacity Populatton Wet Poultry
Capacity PpulaAbn
Cattle Capacity Population
❑ Wean to Finish
❑ l a er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
�Feederto Finish
;i,��a �
` _ .
l � p
❑ DairyHeifer
❑ Farrow to Wean
h a..
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
"'
El Non -Dairy
❑ Farrow to Finish
"` ❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Nan -La ers
❑ Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Co
❑Turke s
I
Others
�'`` ° ❑ Turke Poults
❑ Other
❑ Other
I11111-
mbeof Structures
Discharges & 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
❑ 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
C'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LS No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

oo7g
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f'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): Q .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
RNo ❑ 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? 13 Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
&No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
D3No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
fZ�'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 El Evidence of Wind Drift ] Applicyyationn��Outside of Area
12. Crop type(s) Clttial
13,9,M4MOO; SG 0 '. Fe' le e ( I'D�� 1 , co"" j''�T f'.S�OY%tA/hr
L
13. Soil type(s) �L 1CP 'i _ �Q ��?1b �lYa Coo Pe r-
./ J 1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ER 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
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5j[No
❑ 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):
ReviewerlInspector Name sC �' Phone: ��X3
Reviewer/Inspector Signature: Date: of I
12/28/0 Continued

FAcility Number: Q Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes 5�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [RYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections C? Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5iNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D?No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LN�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NI -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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PTNo
❑ 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
kRNo
❑ NA
❑ NE
Additional Gommen&° iAd/or�DrAWings =
a � }
AL
7, Plea e_ wo, anew bmtesfob ot, I ar o a , 0ve-alI toyer m�.�od .
l�L inftiltj I *ft)c 7 1 0)�) IrisFC
`--"1/„�n�i
5�v4eswve7 by Da, goil�y Dec aDbe� S�?OlwPc� y8�o Sfvd9�4o e�rol�,►t
Pleav plo,, lon s��d�e cl't�►�--� wl,}� Iry yeas,
;nl�l ( Vert -0t./)l aid te(ordr, excee PT no44 above,
r
Page 3 of 3 12128104

Facility No. 73 Farm Name f Date
Permit -" COC OIC_ NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
!D
Slud a Depth ft& %
4122
Liquid Trt. Zone ft)
3,351
5,07
n LJX '- i, 1 m r_
Calibration Date
■ - . .
• 5 .------,
Soil Test Date I q
pH Fields i- I,I
Lime Needed
Lime Applied
Cu Zn
Needs P
Crop Yield — " `1� r�
Wettable Acres
WUP
Weekly Freeboard _y
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Ili _�
r
! v'
i
Venf PHONENUfU B& T
B S and a illations �•�yv� J +
Date last WUP FRO Date last WUP at farm
FRO or Farm Records .-)
Lagoon # _ 5-
Top Dike
Stop Pump 4 6• q
Start Pump 4t •8
I r"7
App. Hardware

BjkS 051a)fog
t
Type of Visit §k Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit IQ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time.
® iV Departure Time: n r County: k Region:
,
Farm Name: 0_S&aCAUtrq 1=6/m
q. H Owner Email:
Owner Name: OSC&' U i Phone:
Mail
ing Address: 49q Mcleyn KOL. L�dJow MG o�S�
Physical Address:
Facility Contact: Title: Phone No:' 7 2 M38W
Onsite Representative:: __ Integrator: S10
DUC Certified Operator: .IVr1GL A.-Ary Operator Certification Number: 0�70
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E:1 0 0 ' =" Longitude: = ° = I El "
Design Current;Design
Current
Design
Current
SwineL': Capacity Population
Wet Poultry Captacpty Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
OFeeder to Finish W 0
Dairy Heifer
❑ Farrow to Wean
Dry Poultry �;'-_
❑ D Cow
❑ Non -Dairy
_
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
El Beef Stocker
El Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑Beef $rood Co
x .Y.
❑ Turke s
Other -
... -
❑ Turke Poults
-
Number ofStruetures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes bNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �R] No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes RNo ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: d - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 15tNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: SOVII Q?Q- _Lfte ye-,
Spillway?: , rr'n'hUPA-rjV
'1
�i
Designed Freeboard (in): 11q
Observed Freeboard (in): VS33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes W 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 D9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UNo ❑ 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 93Zqo ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IQ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
CR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/inspector Name . 1-1-nAly 904jyf_�'1 A Phone: 91)-L1W3
Reviewer/Inspector Signature: Date: OrUnk
U ,... 7 _I 2 U 17/74/O.4 !'nnfia�r�nA

a
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I'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. ❑ WLJp ❑ Checklists ❑ Design ❑ Maps p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JRYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking IRCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
51 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ 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
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
$�'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tR 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
tR 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
1P 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
'�jNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments ziiidlor Orawln"`+� ';� ;
a 1, f fewe. have. Qua i Iable *&, crop reeort 4an We I
4 welt M4K6kkn�
Page 3 of 3 12128104

Facility No. 07—a"7g: Time In Time Out
Farm Name (—)Scg-1/y Integrator
Owner Site Rep _
Operator
Back-up
COC
Circle: General or
No.
Date M 1
No.
NPDES
Design
Current
Design
Current
Wean —Feed
Farrow —Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Design
LT=.3 -25
Sludge Survey �a) d] _n
Crop Yield
Rain Gauge NC117
,/Soil Test Y 11(011 — Wedable Acres V
!��_
Weekly Freeboard �}z Daily Rainfall Z—
Spray/Freeboard Drop _
Weather Codes V/
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
3,
Win
a-
Observed 1+
Calibration/GPM / m
v /jd�1��
Waste Transfers 10
Rain Breaker hq
PLAT y $ �H
1-in Inspections i4b•�
5�
oscv ' '
Date Nitrogen (N)
10115-10-7 a•a
Pull/Field Soil Crop Pan Window

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
I 0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f (z) Departure Time: 142, Dic), I County: 1% o�i+✓:
Farm Name: rOwner Email:
Owner Name: _i2 5 -,e— y Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: r Title: Phone No: _S__d6n1/73L
Onsite Representative: Bert rL 44 4:1A '7 Integrator: GOZL 5Adw4f
Certified Operator: L M a Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [= o = 6 Longitude: = o =' = 11
,Design Current _ Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
2 Feeder to Finish o qD0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ 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?
Design Gurre
Cattle Capacity Popular
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
I
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 [9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[--]No
❑ Yes
;K No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection �(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): *�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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 [4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rj da./ l3FS,, f Fe!n-3GN L► /Gorn
13. Soil type(s)
v • Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
D&No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Z—� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Rectnired 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 JZ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. $Eyes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
64 No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
54 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[. No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104