090095_INSPECTIONS_20171231

41
Division of Soil and Water Conservation [3Other Agency
® Division of Water Quality
IS Routine O Complaint O Follow-un of DWO inspection O Follow-un of DSWC review O Other 1
Facility Number
Date of Inspection
Time of Inspection U hr. (hh:mm) .
13 Registered 0 Certified © Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated:
Farm Name: !C(.-....iT County:............ ..................................................Ec......
A.........,f''`1..... - ...
Owner Name:----.......4ea L f ....................................................... Phone No: � �d l T :.. 1� ..................
Facility Contact: .......V....d .,N'its........... -,4' ....................... Title:................... . Phone No:
...............................................................................................
Mailing Address:-----...�...��,.G..t`�............�...........,L114. ........................................................ .............
Onsite Representative: ...... !��...... az� 04 .............................................. Integrator:...... �..... .r .
Certified Operator;..-.-... ...:................................................... Operator Certification
......
Location of Farm:
....----F---- +K• -- ----------------------- ...------... ........... . .... w
Latitude 0 4 « Longitude ` 99
Swine
10 Wean to Feeder
Feeder to Finish
Z d
Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Current"'
y Popula`tion {
`. ❑.Non -Layer
;
❑ Non -Dairy
❑ Other
Total Destgn Capacity
Tatal•SSLW
xl
Number of Lagoons IHoldtng Ponds /t ❑ Subsurface Drains Present JrD.agoon Area ID Spray Field Area
:�'Y+x'�i^�C"• v �.St - -7..t .,-a ,� rcx*r sa` ,Y-... „� ..� Presw. �a �. ... ... ... ... � �... f-�'"cR+i��'.
x,�yero. - x. ,a r•.r , «n iae w�"a4h r �` t A" Zr ti ,ysf: T as �a Sus""'
�,,,� ,� �_°_� �x �,,., A ,� a � �� �' ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes hNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes KNO
c. If discharge is observed, what is the estimated flow in gal/min? a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes PkNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes kNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes )�No
5. Does any part of the waste management system (other than lagoonstholding ponds) require ❑ Yes KNo
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes kNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes XNo
7/25/97 Continued on buck

• 1�
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier_
Al
Freeboard (ft): ..............
10. Is seepage observed from any of the structures?
11, Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes XNo
KYes ❑ No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type d _.�I. e�: ril F. #-........................................... ................................................ .... .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does.the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facili
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[] No.violations-or deffeiencies.rvere rooted during this;visit~ You:wifl receive•i�o�furth:er"
' ctirresphhdehce about this'visit:
❑ Yes XNo
❑ Yes X-No
)KYes ❑ No
❑ Yes XNo
❑ Yes XNo
XYes lokwo
El Yes kRO
❑ Yes )(NO
E) Yes XNo
❑ Yes XNo
❑ Yes )(No
❑ Yes �No
❑ Yes XNo
❑ Yes �No
❑ Yes ?�No
64/,, ir<CA/. /o.� l•s�
//
�e'E!/ jSC'h�`'t'� �'c:✓ ^ 7/25197

Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 11 D Time: '©OD
C Not Operational Q Below Threshold
Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated orAbove.
Threshold:
Farm Name: ila=auPw: t County- 2bo
Owner Name: ,,,,,,,,,,,_ g ��,04. _. Phone No: t D _ 6 Y8 00_`j
Mailing Address: _ .� Q.. •�. _!_� — __ 2 S- 3�
Facility Contact: - ..- -- Title: Phone No:
. -
Onsite Representative: G�.vt G �a► ' T Integrator: .,._ �. g
Certified Operator: ._------ f4e::,g 14L-- ,,,,,,,. � � �,,, _ , , � ,, Operator Certification Number:
Location of Farm:
Swine ❑ Pouftry ❑ Cattle ❑ Horse Latitade ' Ems- �" Longitude • 4 �u
DiscliaMeS & Stream IM4 aCtS
1. Is any discharge observed from any part of the operation? ❑ Yes R.,No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes WO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RNo
Structpre 1 Saucture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard (inches): 24
I2/12/03 Continued

FacilityNumber: 41 — Z Date of Inspection I l O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 29 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ )
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Wo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceJimprovement? ❑ Yes R No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes RNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �iLr�aL ine.� Svrt . prnuw rsJ�c seeoR _ [ arr. , L.Jl~e a_`' So.i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)? ❑ Yes &NO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes ,ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes 5d No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lank of adequate waste application equipment? ❑ Yes E[No
Odor ]sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 JqNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ];;kNo
roads, building structrrrr, 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 RNo
Air Quality representative immediately.
❑ Final Notes
] Z . F ,.� +4, TA R- Z 46 w S , if a.� errs '"�} i rr: � ivv. w� _ te. S� c-v t,'
�-^trP Leo Lt Pam¢ au+-,t e. a ` p(,-
Your Was#'G- �e,,,,., • AC,i mf ieL
ry C Ae Z veeA �� ; o.... •1 u t.{ a,4L S cr- e- i `,­
a-C Ia•fr G4uv AA-f .
Reviewer/inspector Name
Reviewerlluspector Signature:
Date:
77/77/n2
!'nnfinnal

Facility Number: 'T — '7Date of Inspection { O
Required Records & Document;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 19 Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ief WUP, checklists, design, maps, etc.) ❑ Yes H,No
23. Does record keeping need improvement? If yes, check�Ys7omsloil
riate boa below. ❑ Yes SNo
❑ Waste Application ❑ Rwboa&00'0 Waste AnaSamplt*-'
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Jallo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes EkNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ird discharge, fiwboard problems, over application) ❑ Yes J[No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JRNo
28. Does facility require a follow-up visit by same agency? ❑ Yes WNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Wo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ILYes ❑ No
3I _ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes KNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes KNo
35. Does record keeping r NPDES required forms need improvement? If yes, check the appropriate box below. JXYes ❑ No
❑ Stocking FarCrap Yield Fordo ❑ Rainfal�UInspection After I" Rain
❑ 120 Minute Inspe=oW/❑ Annual Certification For
No violations or deficiencies were noted during this visit. You will receke no farther correspondence about this visit.
,�, � . 7t•..,,i ,,,,..,,�1. �tai (' Y-Yie:. r exQ�-S: wf--
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(ao+t— -ti.L c OC-- u..�•.� 1� r+"q
3S, F'l s,er Lee su c� AM .,:.� ,`� 4f 4,c- dve - y f'Lt 3q--.Ae.,r' '-H-
i•►�: c�,i-mow Yoe vQ o` c.�-�r-�C `�"� uvar�rer s�sic-mow -
;,. sP ecf �o `tom
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I2J12t03

d
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other �❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r� Coanty:-`" Region:
Farm Name: 140r6 Id Pq -f - _ Owner Email:
Owner Name: go-VAgo-VAd pwT Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S L . Y►1 f0
(� Phone No:
Integrator• T1 P41 P
Certified Operator: Operator Certifieation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o= I= u Longitude: a n 0 A= 66
Design Current
Design
Current
Design Current
Swine Capacity Population Wei Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
10
Layer
❑ Dairy Cow
❑ Wean to Feeder
10
Non -Layer I
❑ Dairy Calf
IQ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish El Layers
El Beef Stocker
❑ Gilts El Non-Laers
❑ Beef Feeder
❑ Boars El Pullets
❑ Beef Brood Cowl
❑ Turkeys
©titer ❑ Turkey Poults
❑ Other ❑ Other
Numtter of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t No ❑ NA ❑ NE
El Yes
El No ANA
El NE
❑ Yes
❑ No
5iNA
❑ NE
❑ Yes
❑ No
O-NA
❑ NE
❑ Yes
[ 1No
❑ NA
❑ NE
❑ Yes
tallo
❑ 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?
a. if yes, is waste level into the structural freeboard?
Stnjture I Stnicture 2 Structure 3 Structure 4
ldetztiTzr:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 tt G
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes to
o ❑ NA ❑ NE
❑ Yestuctu
A ❑ NE
51ructurc 5 rc, 6
❑ NE
❑ Yes
No
❑ NA
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No El NA El NE
maintenance or improvement?
Waste Aun ication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Te No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑]/ Ettvidence of Wind Drifl ❑/Application Outside of Area
12. Croptype(s) -(;FmQ6i &aj
13. Soil type(s) Ctile •f� rr�l,,6ti. Jo 1 H
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ((� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes KQ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 1PNo ❑ 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):
k
Reviewer/inspector Name Phone: lfI-t/
Reviewer/Inspector Signature: Date:
1212VU4 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesZNo
No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V,No
[:1 NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
K] No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
[_1 Yes
F] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PS No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eallo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fp 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
CpNo
❑ 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
1� No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
19 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
t9 No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit IgCompliance inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 18r Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t OQ Arrival Time: ® Departure Time: `ft7 County: Region:_
Farm Name: 17"a& Fvtn'1 _ Owner Email:
Owner Name: q n?rd pa 1 Phone:
Mailing Address: to &R_ 6� Q __ 'Bladmk" N G
Physical Address: E
Facility Contact: 4ffo ld 'P JQit Title: �^�, Phone No:
Onsite Representative: 1 Q^O ( _ •1� -1 t�` Integrator: T'►��
Certified Operator: Sew oMA&d,-1 _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: F-1 o
Back-up Certification Number:
" Longitude: ❑ ° 0 1 0 "
Design Current
Design Current Design urrentillillill
Swine
Capacity Papulatiou
Wet Poult 'Cap��ty Papuiation Cattle Capacity Population
❑
Wean to Finish
10 Layer
❑ Dairy Cow
❑
Wean to Feeder
10 Non -Layer
❑ Dairy Calf
Feeder to Finish
aq 9 IR Q
❑ Dairy_Heifer
❑
Farrow to Wean
Dry Poultry ❑ Dry Cow
❑
Farrow to Feeder
❑ Non -Dairy
❑ La yers
❑
Farrow to Finish
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
❑❑Beef Brood Co
Turke s
❑
Gilts
❑
Boars
Other
❑ Other
❑ Turke Poults
❑Other Number of Structures:
Hui
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes S No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
Page I of 3
12128104 Continued

c
• Facility Number: —0095-1 Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5?7No ❑ 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): 19
Observed Freeboard (in): 30 -V-
S. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes 14 No ❑ NA ❑ N E
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CE(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? 2TYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1517No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? if yes, check the appropriate box below. ,&Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
la Outside of Acceptable
�.Crop
p Window ❑ Evidence of
Wiinnd Drift 4obe—amur❑ Application Outside ofArea
12. Croptype(s) 0�j S C&�'t
A,, .
13. Soil type(s) gvfffl.S'. t Goldtbla►n�l CA -4 : 41m _V- T'&lA4s Lv ; NA .i r 4j&41
14. Do the receiviArRps dffer ff6m- t56"s—edesignated in the CAWMP?
❑ Yes
5?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
9No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
07No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff(No
❑ NA
❑ NE
ifflh=W
t(feo questton�#,) Explain any YE$ anctiity tolbetterY`egpIn' situations. (use addthortal pages as teecessary.):
Reviewer/InspectorName SAII Bier --^�T Phone b)�� 3
Reviewer/Inspector Signature: %A.IAI Date: 060 Oi5
Page 2 of 3 U 12129104 Continued

t
Facility Number: Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 9Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ AUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard �W Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
[5 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
2§No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
'KYes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NNo
❑ 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
EgNo
❑ 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
EgNo
❑ 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
tR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Addiaonal_Coments and/or Drawings`�� =eta`_NO
MA
-
`7,Ov�- had-�,� ��s�d�e la�yorr� malls c�� ��r�� N� -1-o s c� &S(r)' 1 we e
() m L j6 also 0,eek-io �c(et� 4o f,soi Jr O�i- k walls hav� covfp
has CA W H P f Q1/JI pd i�4 cowl 1e6 �`'(1 C al-4/I�i'cr`Y LA Fko -hfQ cW,,,
a0+ �
�4 r
Ca1ibrd,1a,7
flr � lcrls
0*41 jgjooll a� 4s st+ l I�Qt, fdsla�e4r �Ila�
%rp�IM1l� pwWar
ro l
0. 0 '
LEI- wo��eanal ss rvn ov-�- oh May 7 , ��woneei proc�sse
ail r
33. P18ege.YVdf 011 Ia �1 COV1131 1'Fo110Wv$ b, � ��Db
`9 Taki�1G`1 &Halos, CVr�I
a6. Mr.Pa��'s vl c rcrj D�1-aoo� r y
%If )n Cl �oAs I f (eL% w � ft; e
gage s of s 12128104

Facility No.
Farm Name
Owner
Operator
Back-up
COC
Time In 7-30 Time Out Date g10'8S
Integrator
Site Rep r�
No. U
No.
Circle: General or NPDES gfoW ar
Desi n
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: i - Sp-^3.O
Sludge ey 5 l4 [i= a 5
�-T 1
Crop Old � � G 06"A
Rain Gauge daalI j n f
Aff 16l e & p7W
Soil Test a I T Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Observed a 11 a- � .�
Calibration/GPM 1 {YYJ�Y!' C 4sS�*_(��
Waste Transfers k4
Rain Breaker �� &f
PLAT R �- o )Qbf-
1-in Inspections
Weather Codes 120 min Inspections
Waste Analysis: Ggp 64p sh-& 691t
-1 -7 Date Nitrogen (N) Date Nitrogen (N)
117
5I� ITV J a. h 06�n-oafroj R 71�p
jai 1�6b-) s _ �, -
Oa iao 4blao okolm V3 2 y
ri
+c llo�
Pull/Field Soil Crop Pan iJ Window
u r fl !t1 �J'LI1�'1
�/�j 1
■ I O
S 0

G"bivision of Water Quality
Facility Number O Division of Soil and Water Conservation �j�<tw7
Other Agency
(Type of Visit C4'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit &1outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: L�/_ —!2:2-A `Arrival Time: 1 �' n n Departure Time: County:
Farm Name: 6ien42 !,1 � !� ra.,-tm Owner Email:
Owner Name: — -/TQ rQ _ Rr I Phone:
Mailing Address:
Physical Address: f l
Facility Contact: ca�j• -?a ,4 - Title:
Onsite Representative:G"L'`4a'`f .
Certified Operator: f%G>r"I f Q•it-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: EK,n
Phone No:
Integrator: ! l I
Operator Certification Number: c .5ya D-?-
Back-up Certification Number:
Latitude: 0u =' =" Longitude: =° =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current';
Cattle Capacity Po 'Wi ion::
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[-]Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [N 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 L9 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 CA -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? PS Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ER No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 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):
i
x d � �a� C�_ /� r6e5lra694-C O-"'ela
i G'dct up Ypwl~ rna✓eh PbCV7:20 h� ��- rt uo" ��ii f�-2 l '
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date:
i_'iZaiva C annnue4

r
Facility Number: — j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check BYes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ®Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 29 Yes ❑ No ❑ NA ❑ NE
9 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
(0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IN 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
E&No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
[k[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f9j No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Je, M A% FGr + / Cis U 6 I1 r'd �e5 -rD 14e tP7- ' rt. LU i 1
w+•--�- ��,(� 77 e !/" 79 ClDtt S`dy� r iT`cTr�� GdzS.
�. 7
een
F-� �uC���.
�t' /7�tj /`e Ge-"
r 5 ,
12128104

December 1, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Harold J Pait
Harold Pait Farm
1068 Guyton Rd
Bladenboro, NC 28320
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Subject: Application for Renewal of Coverage for Expiring NPDES General Permit
Dear Permittee:
Alan W. Klimek, P.E. Director
Division of Water Quality
' � 1
v�V
Your facility is currently approved for operation under one of the Animal Waste Operation NPDES General Permits, which expire on
July 1, 2007. Due to changes in federal rules, facilities that do not discharge nor propose to discharge may choose whether or not to
retain coverage under an NPDES General Permit. Copies of the draft animal waste operation NPDES general permits and the State
Non -Discharge General Permits are available at hrip://h2o.enr.state.nc.us/gps/afou/downloads.htm or by writing or calling:
NCDENR — DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
In order to assure your continued coverage under one of these two types of general permits, you must submit anaVplication for permit
coverage to the Division. Enclosed you will find a `Request for Certificate of Coverage Faciii1y Currently Covered by an Expiring
NPDES General Permit.' The application form must be completed and returned by January 2, 2007. Please note, you must include
two (2) copies of vour most recent Waste Utilization Plan with the application form.
Failure to request renewal of your coverage under a general permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation of NCGS l 43-215.1 and could
result in assessments of civil penalties of up to $25,000 per day.
If you have any questions about the draft general permits, the enclosed application, or any related matter please feel free to contact the
Animal Feeding Operations Unit staff at 919-733-3221.
Sincerely,
Ted L. Bush, Jr., Chief
Aquifer Protection Section
Enclosures
cc (w/o enclosures): Bladen County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
AFO Unit Central Files - 090095
Prestage Farms Inc
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: www.newaterquality.org Location: 2728 Capital Boulevard Raleigh, NC 27604
An Equal OpporiunitylAffirmative Action Employer— 50% Recydedl10% Post Consumer Paper
Telephone:
Fax I:
Fax 2:
Customer Service:
r�ortitCarolina
(919) �/urally
[phone]
[phone]
[phone]

i
(Type of Visit ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QF outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: OD Z) I Departure Time: TC-7 County:
Region: tJC__X'V
Farm Name: A2if a,! L�rn"_ _ Owner Email:
c�f t�
Owner Name: /� rO, _ Pr' Z Phone: Ct
Mailing Address:
Physical Address:
Facility Contact: Ord e/ Title:
OnsiteRepresentative: _1C/eGs• / /�'•
Certified Operator:Q'rflfT r
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number,'g
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ` = Longitude: 0 0 = I = "
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Lc9f#01 3 to I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Design Current
We# Poultry C►aPacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dai Cow
[Ell Dai Calf
❑ Dairy Heifer
❑Dry Cow
❑ Non -Dairy
ElBeef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Numberof Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
[0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[:]Yes
2!LNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
5INo
❑ 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
iR No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C9 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

0
n
Facility Number: — Date of Inspection O-�}
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 E9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 51 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 19 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J59 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,25&-eMVJg lG'Dr;
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
jaYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JgNo
❑ NA
❑ NE
Comments (refer to question # Explain any YES answers and/or any recommepdations or any other Comm
..
Use drawings; of facility to, better explain situations. (use, additional pages as necessary):
Reviewer/Inspector Name —� T Phone: 9,1V
Reviewer/inspector Signature: Date: j(Tpa�
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ 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 appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking .Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
:9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
25 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
k 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
,A 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R�,No
❑ NA
❑ NE
Additional Comments and/or Drawings
J.'
cca
ev'' Ca✓9 py
ieLol
�at�
6 ii/ 4-Ald t' d
Page 3 of 3 12128104

Type of Visit erl�'o-mpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3% Arrival Time: Departure Time: ! County: Region:y
Farm Name:&4r
r� rrrt� Owner Email:
/
Owner Name: �l�trOL aeI/- d�T Phone:
Mailing Address: _ Lr%r f �_+ �!" �- Gr. -- rat ��b f� > .xD
Physical Address: , -Se- � / 7 7/ 1
Facility Contact: AtLl �f �` Title:
Onsite Representative: ,�/ ; r Ber 1'7L
Certified Operator:✓yL�L_ --- - ���
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= & Longitude: = e =1 = u
Design Current Design Current
Swine.
Capacity Population .. Wet Poultry Capacity Population
I I jj� ❑ Layer
❑ Non -La et RA I
❑ Wean to Finish
El Wean to Feeder
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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 ' .',Cui-rer
Cattle Capacity, rpopJulliti
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy_
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:. i + _j
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)
?. 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?
W
❑ Yes N No ❑ NA ❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
4, No
❑ Yes
(,� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 3r-a
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,g No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?.
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
$4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jo No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
CO 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
Ja No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[0 No
❑ NA
❑ NE
z.
A[liiitional Centslandlor Diawings s
rxzz
r212VO4

Facility Number: — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U 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): -/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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
29No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[, No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > l0% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
§& No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
10 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
54 No
❑ NA ❑ NE
Gomments(refer to�queshon#�Expl�unlany,�YESaanswers�andloruy recommendations o� any other comments
Use drav�tt;gs o�f fac�tyto better ezplam�sitnatrons,:{use adii�honalipages. as neeessary):
,.<1_s
C F,(re- ?A� d /P Ali - �R: j s /Tav� +'�L rr -�� tr�a7�S �m
//4;"f
4+t� 7tr, a e � hl-pts.. p t" l� Av1 7,e_41 '74
�sr�r` a -; 3- r 1ist4 F 74
4
7/7 w11 vo-f- 25 6'rw_ a,t y IJ1ra/'r' //-,#
,S'a0 ►L Q3 + i ii �/i J >�i x 4
Reviewer/Inspector Name at}R."'. "'_
Reviewer/Inspector Signature:" Date: D.S
I2128104 Continued

. _..�-«�-..� ... .-. � � V .•r .-.-....-.-..-.�....-I._-r#.�aT�-,'�.. .=3..�^wry„_,�A»,:-•---�4F�^�.-'s"�.v�r�.. �.� ..-�-.�.-�....-�---•--�-..- T „ ,...' -
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: & Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:1 /p /I777 Arrival Time: JQZtcparture Time: County:
Farm Name: P
iv r*Z ' Owner Email:
Owner Name: �Q! f`DI(,r j0a, - L Phone:
Mailing Address:
Physical Address: � I
Facility Contact: .{J Qi'hQ�s [_Cu ,-q� Title:
Onsite Representative:
U
Certified Operator: s� f'}
Back-up Operator:
Location of Farm: Latitude:
Region:
Phone: f
Integrator: Ps�9e_
Certification Number: T 18 `7 )6
Certification Number:
Longitude:
Design Current
n Current
Design Current
Swine Capacity Pop.
Wet Poul#ry�i#y Pop.C�aitpt�le
RISK
Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
ceder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P.onitr Ca achy P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t?ther
Turkeys
Turkey Poults
Other
Other
I
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)?
❑ Yes ozyo ❑ NA ❑ NE
❑ Yes
❑ No
O)NA
❑ NE
❑ Yes
❑ No
NA.
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No PNA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

,a Off
Facili Number: - Date of Ins ection: O
Waste Collection & Treatment
4. K storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Strut re 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
Ll No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
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 nd Drift ❑ Applicati n Outside of Approved Area
12. Crop Type(s): C �SS V1
�,"r,.5;'
'
13. Soil Type(s): p
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
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 ❑ 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ly
No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25 *Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesP�:No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
❑NA ❑NE
DNA ONE
❑ NA ❑ NE
❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑Yes �]No ❑NA ❑NE
❑ Yes y No ❑ NA ❑ NE
❑ Yes
® No
T
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: f c--g33,3cv
Date: /7
2/4a01 S

Type of Visit: 40 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:�
Farm Name:
Owner Name: rH_cmRe_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: V a' S �`^'` Title: Phone:
Onsite Representative: Integrator: PlIeLk(-°—
Certified Operator: s' �� M� Certification Number: 22D
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
. De gn 'Current
Desig Current Design Current
Swine Capacity Pop.
'Vet Poultry CapacttysF 'Pop Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da Heifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D . P,ouIt . Ca aeif Po
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Boars
Turkeys
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:
❑ Yes P
No [] NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [;EP NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 1�1 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 ONA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 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
P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): :Q �'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste APRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
1 l . 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/Stodge into Bare Soil
❑ Outside of Acceptable Crop W97"6T04d_aL)j
Evidence of Wind Drift ❑ Application Outside of Approved Area
i 2. Crop Type(s).
13. Soil Type(s): �'� l j j O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
No
❑ NA
0 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 N 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 [)3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

"cility Number: IDate of Inspection: Q
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 IM No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes 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 IM 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 [Q No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
[3NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]y
Date: Vro/xe,
21412011

division of i�Vater Resources
Facility Number - Division of Soil and Water Conservation
Other Agency
rype of Visit: 0 Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: + Arrival Time: Departure Time: ��: County:�`/1� Region:
Farm Name: o2;4 Owner Email:
Owner Name: FPhone:
Mailing Address:
Physical Address:
Facility Contact: j6UW5 L44^111110 Title: Phone:
Onsite Representative: Integrator: !
Certified Operator: �' �f Certification Number: 2-2z`o
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Carrent
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Finish
La er
DairyCow
Feeder
on -Layer
DairyCalf
o Finish
Design
Current
Dai Heifer
o Wean
D Cow
o Feeder
F
D . P,oultr
Ga aci
Po
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La erg
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
LJOther
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 M No ❑ NA ❑ NE
[:]Yes [] No
[:]Yes [:]No
❑ Yes [:]No
[] Yes qg No
[:]Yes [R No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: - Date of Inspection: Z
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 M No NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �r
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 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 W No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ig 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? P9
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidenV of Wind Drift 0 Application Outside of Approved Area
11 ��--r;:. r��:S]�L;�'� /; '7�T`.� +-�/Ilf)Pff
13. Soil Type(s): �p 44
14. Do the receiving crops differ fro those designated in the CAWMP?
❑ Yes
(P No
``i%''""
❑ 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
J] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reauired 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 JR 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 ?9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 5&No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Inspection: 23
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
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:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ Yes q@ No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes W No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question i#). Explain any. -YES answers and/or any additional recommendations or any other commentsr
Use drawinzs:of facility to better:expWn.sitvations (use additional -pages. as necessary). p _Lix. ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I' a,ybb _ Phone:9/�"{� >x�
I&P Date:
V4/ 014

Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ' ( t }} Arrival Time: p:. Qq,,,,. Departure Time: 1C, � County: t�tT,�E Region: �(_1
Farm Name: Q o la ��-�- �' Owner Email:
Owner Name: r f b ) � = �Q.t �— Phone:
Mailing Address:
Physical Address:
Facility Contact: X'�� Title:
Onsite Representative: 10
Certified Operator: �• i'• i (-e"7
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: res�u4e
Certification Number:
Certification Number:
Longitude:
Design Current Des gn Current
Design Current
Swine
Capacity Pop. R'et Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
/
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. P,oul Ca acity $o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non —Layers
Boars Pullets
Twke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
rW No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
LP 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
Eallo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaciRty Rumber: q - Date of Inspection: ! 1,v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6g No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No 0 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
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �] 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 P] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;g No [DNA ❑ 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 Acc_e-ptta�b-le! Crop Window ❑ Evidence of Wind Drift J ❑/Applicattion Outside of Approved Area
12. Crop Type(s): k &r" S 0711), C arm , wrtYRi`; gal -I" 3 ,
13. Soil Type(s): Ov A t ��+ IVA, Tiz , Wo
IF
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 [�3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E4 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 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
DNA [] NE
Page 2 of 3 21412011 Continued

aciFty Kumber: - Date of Ins ection: "n ? L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E;-d No ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerllnspector 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes CQ No ❑ NA ❑ NE
Yes
No
❑ NA
❑ NE
Yes
Comments (refer to question #): Explain any YES answers and/or: any additional. recommendations or any other comments -i ;
Use drawings of facility to better explain_ situations (rase additional pages as necessary)::
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
at %
Phone: 0�
Date:
21412011

IType of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: .`,3 Departure Time: = jQ County: "n
Farm Name: V-CO r01L `cat (� iV� Owner Email:
Owner Name: 00►-tf Al Phone:
Mailing Address:
Physical Address:
Facility Contact: �(1�S� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: (7
Phone:
Integrator:
Certification Number: �,7 �U
Certification Number:
Longitude:
5-Coffient
Design CWet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
I jNon-Layer I
Design Current
D , 1',oultr Ca aci I;o
Layers
Non -Layers
Pullets
Turkeys
Turke Poults
a' Calf
Feeder to Finish
q
D Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No EPNA ❑ 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 F1 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes B No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Eg No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: C? f5ate 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Og 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 EEJ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diner trom those designated in the C:AWMP?
U Yes
hn No
U NA
U 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
Rea 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 ® 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 E5 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 B No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E) No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili ' Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
© No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�.] No
❑ NA
❑ NE
ments (refer�to questions#) Explam�any-YES-answers andlor any additional recommendations or,other comments:
FUsedrawings olfacility #o.bettRi plam�sitdaidons (use�as. necessary).
Reviewer/Inspector Name:
Phone: IUD�33'3
Reviewer/Inspector Signature:
Page 3 of 3
Date: ekh1 1
-1
21412014

Ihype or visit: W compliance lnspecuon V uperation Review V Structure Evaluation V rectimcal Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4 1 Arrival Time: I p Departure Time: County:
Farm Name: Aafold Pk Ftwm Owner Email:
Owner Name:ka,�-o U_ 0-1 P4 Phone:
Mailing Address:
Physical Address:
Facility Contact: vi )J __ Title:
Onsite Representative: ja_ kV .e5 C�.tYnNJ
Certified Operator: Sip. Rl e"
Region:
Phone:
Integrator: Pr esAw
Certification Number: aao03
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current -
Design Current
Swine
,�
Capacity Pop -f
Wet Poultry
Capacity
Pop r .-
Cattle Capacity Pop.
�La
Wean to Finish'
v'
er
airy Cow
to Feeder
`
�
N on -La er
airy Calf
Feeder to FinishWean
DairyHeifer
Farrow to Wean
.'
- �'�
' �
i
Desi gn
Cu'��
� rrent �-
Dry Cow
Farrow to Feede
Poul
aaci
on -Dairy
Farrow to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
HGilts
Boars
Pullets
-
Beef Brood Cow
WONTurkeys
Other
TurkeyPoults
Other
fi Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
V9 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
09NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier -
Spillway?:
Designed Freeboard (in):
a
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�?No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T`
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window, ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Yes 0 No ❑ NA
❑ Yes $3 No ❑ NA
❑ Yes M No ❑ NA
[] Yes ® No ❑ NA
❑ Yes ® No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 M No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3
L,
21412011 Continued

Facili Number: q - 927 =1 jDate of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes IV No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
® NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes W No C] NA ❑ NE
❑ Yes [& No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes © No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer,to question ft Explain any YES -answers and/or any additional recommendations or anytother comments.
Use drawines of facilitv..to:better. explain situations fuse additional pages::as necessary). a
-e Cevz� S CE J t`lct.tl-eo'
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
9-Iq _ql
Phone: C00 -- -(33 330n
Date: i `r NI
21412011

Ir
E
f Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 19 3 0 o Arrival Time: Departure Time: County: ajwRegion:
V1_ I c% .1 _._
Farm Name:
Owner Name: Hasid i t
Mailing Address:
Physical Address:
Facility Contact: flsw u Title:
Onsite Representative: --�-Ime?
S `
Certified Operator. �
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:rcS
Operator Certification Number:06
Back-up Certification Number:
Latitude: = v = I = Longitude: = ° = = u
Design Current
Design Current
Design Current
Swiae C►specify Population
Wet Poultry C++specify Population
C►►sale Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
10 Non -La er
1
Feeder to Finish I 79Lhd WS
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
❑ Non-LayNetsers
❑ Beef Stacker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turke s
Other
❑ Other
❑ Turkex Poults
❑ 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 P No ❑ NA ❑ NE
❑ Yes
❑ No
�] NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
� No
El NA
El NE
❑ Yes
Ep No
❑ NA
❑ NE
Page I of 3 12128104 Continued

'10
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
[P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
P No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
`(-' No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or
❑ Yes
No
❑ NA
❑ NE
wet stacks)
4. 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
maintenance/improvement?
❑ Yes F No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
Crop Window El Evidence ofWindDrift`❑ Application Outside of Area 1�
12. Crop type(s) f�' SS l Ir.�M 1 1 ��'1- i)"Ya'cl DPL
t 3. Soil type(s) R-a , G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[P No ❑ NA ❑ NE
[tNo ❑NA ONE
in No ❑ NA ❑ NE
�' "
Comments (refer to:queshon''#f) Explain aiRy YES answers and/or any recom�me a ions or any other commeatts - g
Use drawffigsof facility to better egplam situations: (use additional pages�as�n+ss) F r,
Reviewer/ins ector Name
P
k y [�
`�
Phone: To 4_33r_33m
,.'��
Reviewer/Inspector Signature:
Date: O
Page 2 of 3 12128104 Continued

� e
Facility Number: Date of Inspection 3p O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes P No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El � No El NA El NE
the appropriate box. ElWUP ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
t9 No
❑ NA
❑ NE
❑ Yes
❑ No
P3 NA
❑ NE
❑ Yes
�5 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
YU No
ElNA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
`]
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
[)n No
❑ NA
❑ NE
Page 3 of 3 12128104

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