090126_INSPECTIONS_20171231

Type of Visit: ompliance 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: a -o Departure Time: t q County: /3 Region:
Farm Name:Owner Email:
Owner Name:rSsPhone:
Mailing Address:
Physical Address:
Facility Contact: ` S� ' C Title: Phone:
Onsite Representative: t t
Certified Operator: <sa-M P
Back-up Operator:
Location of Farm:
Latitude:
Integrator: Yq CJ-5 Certification Number: ! < q
'q-Tg2—
Certification Number:
Longitude:
t.;
Design:.
Current
DesillNo gn
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Gettig
,�,
Capacity Pop.
sip
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
S GCSi
.
Dairy Heifer
Farrow to Wean
"
Design
Current
Dry Cow
Farrow to Feeder
D aFoul
F,Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults��I
Other
Other
I: IN
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes [3rK-o— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑1TA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No �A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No ®NA ❑ NE
2_ Is there evidence of a past discharge from any part of the operation? ❑ Yes G�J-No ❑ NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes PT'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: TtjG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
QNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U
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
E]- o
❑ 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
�To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[A -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes 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): Cyr V44A.4 is d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ -*K'o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes [�M'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3-ND ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJK°
❑ NA
[] NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[J-N-o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Ejj-<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FI/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - I Date of Inspection: k sG r /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []J-Nro'-- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2-No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ZLN@
❑ 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
0,Ko
❑ 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
J+lo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[31�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M"No
❑ NA
❑ NE
fits refer to teest�on: Ex IaEn an YES a`" , .'
9 .,. } P „ 3";li nswers aa�i1©rranyl addrtilonal recommendations nr any otltier eommeufs. amine = u „
N �,r.. w�F���.. _ : r� 1 a . v i, ,., n a� . t y ' del
Use drawu�gsiofefac�ty to betterexpla�n s�tuat,ousa(oselladditional pages its necessary). _ ;..r qh _li,.:
C
Reviewer/Inspector Name: j • u Phone: 33"
Reviewer/Inspector Signature: � t P � Lti�.4�10 Date: to"(
Page 3 of 3 21412015

Type of Visit: ll�r'Co Hance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: p p Departure Time: County:
Farm Name: cef D Owner Email:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: l i
Certified Operator: L
Back-up Operator:
Location of Farm:
Latitude:
Region:`
Integrator: �J
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Gagacity Pop.
.Wet Poultry
Design
Capacity
Gurrent
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
La er�
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
S
`...
D : , PouI
Desi
Ca aci
Po" .
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Other
Other
- Turkeys
Turkey Pouits
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[g4° ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
❑ Yes
[—]No
[3-1
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑`ice
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑-NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 011'TA- ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [ff"Ro ❑ NA ❑ NE
❑ Yes En -No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes E3<7
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes L`J 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 ffj`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 8 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3No
❑ 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):
0
13. Soil Type(s): & O
1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [. -o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [] N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C3-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E'No
❑ NA
❑ NE
❑ Yes
0'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3'1io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Fj"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
Ej 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
22, Did the facility fail install Yes �
❑ Sludge Survey
NA NE
to and maintain a rain gauge?
❑
❑
❑
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
L_i No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Faeili .Number: -b I Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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
Comments (refer to question ft Expiain any YES answers and/or any additional: recommendations or any other comments n
Use drawines of facilitv`to`better explain situations (use additional ogees=as uecessarv).:
GA:� �'^' — 9 P
9ta+ Y—ry
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0. 3 . s [ 5• 7
Phone: "lv 3 —'o
Date: g
41
21412014

It Q of 3%s�T 15
Type of Visit: gZZImpliiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Dolio utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time. County:
Farm Name: t, S� Owner Email:
Owner Name: ° _may G`S�{/ Phone:
Mailing Address:
Physical Address:
Facility Contact: 16& Title: Phone:
Onsite Representative: 1 Integrator: pr__s �M5 =
Region: EL�
Certified Operator: Sa wAr!:l Certification Number: If 74 51 1-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
.Swine:. _^pacity Pop.
Design Current
Wet Poultry Capacity I'op.
Design Current
Cattle Capacity Pop.
Wean to Finish
ILayer
Non -Layer
Dairy Cow
Wean to Feeder
Dairy Calf
Ri
Feeder to Finish
Design l►nrre13
Dr P,oulri Ca aci P.o
Layers
Non -Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
TurkeyPoults
Other
_-
Uther. _ : -
Other
_
Dischar es 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)
❑ Yes Ztvo ❑ NA ❑ NE
[—]Yes
[::]No
[J"NA
❑ NE
❑ Yes
❑ No
E3-9A
❑ 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 [a' f�A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E3 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ]6No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: 01 1 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
Lam""
— NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q_b;A-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
''
Observed Freeboard (in): ` 4
5. Are there any immediate threats toFeintegrity of any of the structures observed?
❑ Yes
C20flo
❑ 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
[2rNo
❑ 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
B- o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C] K
❑ 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
Eg-<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[;101�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
21"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
{
12. Crop Type(s):y O PowG
13. Soil Type(s): 6 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2►<
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E] l o
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes l2-1qo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[3 Yes []ollo_
❑ 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 I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 12r❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Fasili Number: - Date of -Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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)
[ vo ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes dNo ❑ NA [] NE
❑ Yes I_J No ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
❑ Yes E�(No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ZNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes dVNo
o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
y �
Date: 6 !�
21412014

(Type of Visit: ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q1 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 4.1, Region-7y
Farm Name `Qs Owner Email:
Owner Name: G YIL I _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: '-S�C&UA_ e Title: Phone:
Onsite Representative: K''i Lt✓' Integrator:
IL
Certified Operator: �� L 9--4 Certification Number: S 2
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
_'� Design
Current
Design Current
Swine @opacity Pop.
Wet Poultry Capacity
Pop.
Cattle ..- Capacity Pop.
Wean to Finish
Layer
iry Cow
Wean to Feeder
on -Layer
iry Calf
Feeder to Finish'
Dairy Heifer
Farrow to Wean
tea.
Design
Current
Dry Cow
Farrow to Feeder
`D' afoul Ca aci
P,o
Nan -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
k
Turkeys
Other
Turkey Poults
Other
I
Ll
Other -4-
_
DischarEes and Stream Impact
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Io ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [:]No []�<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [BNA ❑ 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 ft�<A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ No []<A ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

a
omed
Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�'M ❑ NA D NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ 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
[]I<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[144'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(2'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U to
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vo
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a 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): 43er" My f�S '24
❑NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
11<0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
t_ pCo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
to
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
—
0 NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
FLR 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
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[;Pl�o
❑ NA
❑ NE
Page 2 o, f 3 21412011 Continued

R
0-
[Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 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 Q5,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Wo
❑ 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
Ckio
❑ 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
[rNo
❑ 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
[]KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
[Z10
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[g-l�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments= i
Use drawino of facility to better explaiiiaituations (use additional ones as necessarv).
S(aje Ski"
Reviewer/Inspector Name:
a- If - 13
6 P-( , 2_0(3
Phony-0—
Reviewer/Inspector Signature:
Page 3 of 3
Date: 4 0
2✓412011

Type of Visit: �mpliance Inspection V Operation Review C3 Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: 17-1,Arrival Time: fl Departure Time: 12/ " I P—J County: rw
Farm Name: , O k-rt j`� S S, F7 jeft Owner Email:
Owner Name: �i2 �; Lr Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: r
Certified Operator: Grp
r �
Title: r e .
Integrator:ell
Certification Number:ys-
Region:
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
-: -
Current
Design Current
Swine
Capacityp .� Wet Poultry
Capacity
Pap{
-Cattle Capacity Pop.
s
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Weeder
to Finish
Da' Heifer
Farrow to Wean
_
Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
..
.. w.:.
R+u.., n.:=','.m.
.IAA,......,._,.t....,.,...................�._—.�...........
Other
—. _.. 111
Wd.'l ,:_Z
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes .R No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ 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 [allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility lumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
�iXNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C&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
CNo
❑ 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
QKNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S;rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
gg-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JRJ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cg-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):ffJili.��,y%
13. Soil Type(s): � x
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 0,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Ppo
❑ 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 jg-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ERNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

` Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F;2 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?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[]Yes (Ul No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Q No ❑ NA ❑ NE
❑ Yes 2[ No ❑ NA ❑ NE
[:]Yes g No
[:]Yes No
❑ Yes O—No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question {: Explain any YES answers aud{or a`ny_:additionaE reeoinmendations or antyo"th4er c0inme"�ts.
Use drawings of facility to better explain situations:(use adrlrhon it ;ges.as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `J- &-j13�--3300
Date: 7 r3 —2-6 ��-
2/4/2011

i
Type of Visit Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up Q Referral O Emergency Q Other ❑Denied Access
Date of Visit: c©_ LArrival Time: Departure Time: County: Region:
Farm Name: Lr o Owner Email:
r—
Owner Name: ,D .o ea 41A Phone:
Mailing Address:
Physical Address: .
Facility Contact:
Onsite Representative: �r
Certified Operator: Sa-rt�
Back-up Operator:
Title:
Phone No:
Integrator: xcaa,�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 t 0 « Longitude: = ° = 1 "
Design Current
R Design
Current,
Design
Current
Swine
Capacity Population
WetPoult Capaty
PoP ulattan Cattle
Capty
Population
❑ DairyCow
❑ Wean to Finish
Layer
FEI
❑ Wean to Feeder
Non -Layer
❑ Dairy Calf
t ❑ Dairy Heifer
M:
Feeder to Finish
ElFarrow to Wean'*
xr DryPoglty..:.
ii'<tr}* ❑ D Cow
El Farrow to Feeder
El
❑ Non -Dairy
La
Layers
El Non -Layers
❑ Pullets
❑ Turke Poults
El Other
Discharges & Stream Iro�acts
1. is any discharge observed from any part of the operation? El Yes UR No El NA ❑ NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? El Yes ❑ No El NA [I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes [I No El NA [I 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) El Yes El No ❑ NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes �10 El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes �do El NA El NE
other than from a discharge?
Page I of 3 12128104 Continued
Discharges & Stream Iro�acts
1. is any discharge observed from any part of the operation? El Yes UR No El NA ❑ NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? El Yes ❑ No El NA [I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes [I No El NA [I 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) El Yes El No ❑ NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes �10 El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes �do El NA El NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: Date of Inspection T-%I
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ 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): f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
29 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�&No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Z No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U,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 F�!LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JgNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) . Vjn vp.(,f
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 MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes IN No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes KNo El NA El NE
❑ Yes Q No ❑ NA ❑ NE
.. q �a y a�
Comments-(r re
U wings of facility to betters aplas�Euahoiis (use add�tional� ages as necessaryt oan bother comments. an YESVtanswers and/oran recommends
AL
U. fJe lr
Reviewer/Inspector Name �— W �� Phone: 2/f�'7=/�3-330'�
Reviewer/Inspector Signature: Date: —
Page 2 of 3 12128104 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box.
❑ W[JP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IR No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
91Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M.No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Rvo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Rvo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R;No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
;FLNo
❑ 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
Wo
❑ NA
❑ NE
"Fw
" t r .
mr
Additional�,Comen#sand/or Drawntgs
AL
Page 3 of 3 12128104

1 LLZ:
Date of Visit:
Farm Name:
Type of Visit &'CCommp�pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit &<O—Utine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Arrival Time: Departure Time: County:
R4A ��t�SC.c A 2 Owner Email:
Owner Name: _Ll,?�T V rS5 t • _ Phone:
jr
Mailing Address:
Physical Address:
Region: 4RQ
Facility Contact: hL-Gr— Title: Phone No:
Onsite Representative: _ U / e� _ Integrator:
Certified Operator: ^ ��` �'� Operator Certification Number: /17 91;1CL
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: Q o Q 6 =
Design Current
Design Current
Design Current
SRinC Capacity PopulatiTJF0_"_
nitly Capacity Population
Cattle Capacity Population
❑ Wean to Finish
La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
[o Feeder to Finish i� r
❑ DairyHeifer
❑ Farrow to Wean
Dry Poaltry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other 3L❑
❑ Turke Poults
Other
Number of Structures
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
q,�jJNA❑ NE
El Yes
El No
B
L'NA ❑ NE
I� NA ❑ NE
❑ Yes
No
El Yes
�❑
1� No
❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

t
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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: — - P1'1,�,_
Spillway?: (Q/
Designed Freeboard (in): �.-
Observed Freeboard (in):
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 ffNNo El NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ®< ❑ NA ❑ NE
❑ Yes P<o ❑ 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? El Yes l�l oo ElNA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Po El NA I--]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 Elti,d K Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes Q No ❑ NA ❑ NE
maintenance/improvement? �,�
] 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ElE Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ,mivil Z1�5_1 �. Q . _. .
13.
Soil type(s) )p 96
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&<o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�L'�,/N'o
'
91
[IElNo NA
NE
17.
Does the facility lack adequate acreage for land application?
ElYes
[9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L?1' o
❑ NA
❑ NE
;Comments refer to question • Ex lain an YES ansRers andlor an recommendations a n o er commen s
'Use drawings of facili to better explain , psit - y .�y,� Y
g tyuations (use -additional pages as. necessary)
AL
T
e Phone:
Reviewer/inspector N;ture:
ReviewerlInspector Si Date: [�
Page 2 of 3 // O 1248104 / Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
o
El NA
ElNE
ElE Yes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
al Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspectionss
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
/❑
It�'No
❑ NA
Cl NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Qj<
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Llj� Alo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
il i o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El2 Yes
,—,
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L44 ❑ NA ❑ NE
Other Issues ,.,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 03 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ 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
ENo
❑ 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
El Yes
,�
fJ 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?
El�,
Yes
� No
ElNA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
ffNo
❑ NA
❑ NE
Addtbonal Com�tuents auWor`Dr v n s:
Page 3 of 3 12128104

/o-o9-zoo 9
q ivision of Water Quality
Facility Number 0 I /Z �p 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit &In'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
3(o n* Departure Time: '/ County: J6IQde-Al_ Region: Gi�O
Date of Visit: -% 09-49 Arrival Time: 3 p � ty g'
Farm Name: Re erg' ; g u Fca.lri... '4 2- Owner Email:
Owner Name: Rn (0Cr-� ::Zy_4.S.57a Phone:
Mailing Address:
Physical Address:
Facility Contact: I<dAh g.`�Y4-f-V' Title: SP<-� • Phone No:
Onsite Representative: _ 9444 �3 Say-ke 4 -D_ _ Integrator: r r4S64�� �►'Lv1
Certified Operator:--Rn�jey4 _ +tQ _ Operator Certification Number: / 99ZZ
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E::] 0 0 ' = « Longitude: 0 ° =' = u
Design Current Design Current Design Current{!A
Swine 73'Capacity Population WetPoultry Capacity Population Cattle Capacity Popiilations"
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse imparts to the Waters of the State
other than from a discharge?
❑ Yes [3 o ❑ NA ❑ NE
❑ Yes
❑ No
E A
❑ NE
Yes
No
E'�A
❑ NE
r❑
�❑
L1%A
❑ NE
❑ Yes
No
El Yes
[❑,
L''I No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 09 —12 (p Date of Inspection -09
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q 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): 0
5. Are there any immediate threats to the integrity of any of the structures observed? Elyes ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ffNo ❑ 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 1"hrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yes No ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No El NA [I 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 C KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �.rhn � h S+'NQ.it Gral"
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L7NNo ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? El yes B N/o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes C1 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,., NNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑Yes Lf'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):
Reviewei-Anspector Name jy C �V� $ Phone: g10.44 •33,V/
Reviewer/Inspector Signature: Date: —p 9 —ZOO
11/161W Continued

Facility Number: V 09 —/;2& Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Desig
n El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B 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
S No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I_7 o'
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2'90
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B'�lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0-<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 310 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
!T 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
D o
❑ 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
L] 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
Now❑
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
L'I"No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 6;6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Olo-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I V-L74-,051Arrival Time: /-00 t. Departure Time: County: �� Region:
Farm Name: 1 0 Z Owner Email:
Owner Name: r U Phone:
Mailing Address:
Phvsical Address:
Facility Contact: pyg4w Title: Phone No:
Onsite Representative: 25Y Integrator:
Certified Operator: .RP-12 l /A Operator Certification Number: �i 9Z z__
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = a [—]' = « Longitude: =° [= d
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry
Capacity Population
CattleWCapacitymPopulation
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Non -Layer
❑ Dairy Calf
DairyHeifer
Dry Poultry
" W
❑ D Cow
❑ Non -Dairy
La ers
❑ Beef Stocker
Non -La ers❑
ro
Beef Feeder
Puliets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
❑ Wean to Feeder
}ceder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
FEIGilts Boars
Dischartres &Stream lmtlaCtS
1. is any discharge observed from any part of the operation?
❑Yes
[9No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field El Other
a. Was the conveyance man-made?
El Yes
[2Na
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (]f yes, notify DWQ)
El Yes
R No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does discharge bypass the waste management system`? (]f yes. notify DWQ)
❑Yes
P? No
❑ NA
❑ NE
?. Is there evidence of past discharge from any part of the operation`'
El Yes
P?No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
O No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: —/z.�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S49
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 V1 No ❑ NA ❑ NE
❑ Yes PI No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes [4No ❑NA ❑NE
❑ Yes t 1 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �M 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 rO No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need El Yes [�No ❑ NA ❑ NI-
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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) B � Ywt h- � k S• G__ • p .
13.
Soil type(s) Alo B
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IF No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VTNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
IT
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
53 No
❑ NA
❑ NE
Comments (refer to question { Explain anv`YES answers andlor any recommendations or spy other comments "
Use drawings of facility to better explain situations -(use additional pages as necessary}
Reviewer/Inspector Name } r`[r�Cyws .; _:
Phone:/O.33. 3330
Reviewer/Inspector Signature: g
Date:
Page 2 of 3 12128104 Continued

• ` 1%.
Facility Number: Q —/Z 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 CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ W Lp ❑ Checklists ❑ Design ❑Maps El 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 V Rain Inspections ❑ Weather Code
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
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
0 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
Pj No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P9 No
❑ NA
❑ NE
Page 3 of 3 12128104

ewl7te d fro RQ 7-2�-Z007
a
Facility Number Q J Z (p
*-Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit A& Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit (b Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /7 -p Arrival Time: /O : p Departure Time: JZ ; p County:
Af
Farm Name: plot elv+ A41-0- 7- _/�,1� Owner Email:
Owner Name: Z bw T lfewvy M-a-uD Phone:
Mailing Address:
Physical Address:
Region • «0
Facility Contact: Kbbty- f-- -1 a TS�tD_ Title: Phone No:
Onsite Representative: Integrator: 4- 4 S e
Certified Operator: P-a bt*4 3'GSS� Operator Certification Number:
Back-up Operator: Sakigjej f/ .l ��rn�cr _ Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude: ° =
di
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Gurre'
Cattle -Capacity Popular.
❑ Dairy Cow
❑ Dairy Calf
❑ Dat Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [4No ❑ NA ❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128/04 Continued

'
Facilih, Number: QCI — /Z (p
Date of Inspection©—O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[XNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
g
Designed Freeboard (in): 3 Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-+6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[)3 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
[6 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
[;9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) J<ev^f g, d"_ ( tf eL,, _ 5j�t4lf Kr..
13_ Soil type(s) Aln 13
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[5 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[?fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name K J F k w414-S Phone:
Reviewer/Inspector Signature: Date: — Z — ZDO
12/281W Continued

• 1726lity Number: Oct — Iz Date of Inspection 7—/2 --0
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EgNo ❑ NA ❑ NE
the appropiate box. ❑ VAR ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QPNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
.V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ufl No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CO No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P9 No
El NA
El 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
IN 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
P] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
12129104

Type of Visit �mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Mine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: QQ 't Arrival Time: ; (7 Departure County: Region:
/ti Farm Name: plefzt- K __/ ASS �IS�m a Owner Email:
Afl
Owner Name: �2� en fY (lsd Lc 2 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7KA' tV. ASd.
Certified Operator:��
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: / 22&Z
Back-up Certification Number:
Location of Farm: Latitude: [--] u ❑ ' ❑ « Longitude: = ° = '
DesiAfflGurrent
Design
Current Design Current
Swine
Capaulation
Wet Poultry Capacity
❑ La er
❑Nan-1 a er
Population CatEle Capacity Population
❑ DairyCow
❑ Dai Calf
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/ a
❑ DairyHeifer
❑ Farrow to Wean
D . Pout
rY
b ❑ D Cow
❑ Farrow to Feeder
❑ Layers
Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
100ther
❑ Beef Feeder
= El Beef Brood Cowl I
Nu° tuber of Structures:
Vit w
�[j Boars
Other
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
91 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
It No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ZNo
❑ 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
R.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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

• Facility Number: — (0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):r2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JQNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
&No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
91 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5a 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
IN No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes . dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 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. Croptype(s) EZn!fA 1,L DUY ;S'Cr�
13. Soiltype(s) ' 1Qa1
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 13 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes Ca No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;qNo ❑ NA ❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary,);
Reviewer/Inspector Name ��� ( v 8liJ"'�' Phone:
Reviewer/Inspector Signature: Date:
Page 2 of-3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gl No ❑ NA ❑ NE
the appropriate 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tR 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
J4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
`W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
14 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
54 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
Additional. Commentsiand/or, Drawings: r
0.l EctC e 1 j w �45 �m s-�oo�4 Ilf Bk�C h d� O'er rt_
0?3•r I
r `�
Page 3 of 3 12128104

Type of Visit {2 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit J*Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: r� Arrival Time: z = d0 Departure Time: County: Ai!!i Region: F/e-0
Farm Name: f�77 Owner Email:
IL
Owner Name: Qnrrb� SS Phone:
Physical Address:
Facilitv Contact:
Onsite Representative: tT
Certified Operator: � -'X
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
[i012 7-
Location of Farm: Latitude: 0 e = 6 = Longitude: [= ° ❑ g ❑ «
Design Current^ Design '- �x , Design Current
SwineWet Poultry Capacity PopulahCapaci❑
*nc%
Wean to Finish ❑ La er Dai Cow
❑ Wean to Feeder ❑Non -La e3 ❑ DairyCalf
GgFeeder to Finish
sx ❑ DairyHeife3
❑ Farrow to Wean
�' t ❑ D Cow
Dry�Poultry �
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
Gilts
❑ Beef Stocker
❑ Beef Feeder
H—iBoars
❑ Beef Brood Co
..
x..,Turkeys
Other
c►
Number ofpStructures:
_ - ; 1.'�r, d4_', .is`.e�'1.8,-a-.i%v. S .Sr..tY ,� � }•..7i .
❑ Other
❑ La ers
❑ Non -Lavers
❑ Pullets
❑
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
LNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
9 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
51 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EgNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility dumber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier: I
Spillway?: e
Designed Freeboard (in): 3
Observed Freeboard (in): ZGi
Structure 3 Structure 4
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 JgNo ❑ NA ❑ NE
❑ Yes ❑ No tK NA ❑ NE
Structure 5 Structure 6
❑ Yes B No ❑ NA ❑ NE
❑ Yes 9No ❑ 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 159 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Aviv ❑ 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 29 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) & rwt�_- i 3oS St+�tw:� q ra - Ltia.�q �50�
13. Soil type(s) 9
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 [NNo ❑ 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
[K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
14 No
❑ NA
❑ NE
L(. /Vcco� i +^4{,� �Et.� u;gp[s1� d�5 4 r '�f"� �r p
V
i S 4.Pe, ee- Pt V `! inc4
J or a Zs-1 r - tK kr 4ro rwA
elU .)a LC, .�.o) 3 I " _ ae s;
�,r.� �i-e��oo You
"< < 40 +.Lc a Q_cb; , -4te-
u3as4e i evJ
i s w �- K
00
Reviewer/Inspector Name
``'r
,.
Phone:
Reviewer/Inspector Signature:
Date: Itzil
12128104 Continued

Fgcility'Number: �' — �Z(p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP� ❑ Checklistw, ❑ Design,-0 Maps- ❑ other
21. Does record keeping need improvement? If yes, check the appropriate box below. J.Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections CKMonthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
29 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ElNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? /%V
❑ Yes
PRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
21 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 PS No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
m 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
0 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
O.No
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32. Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
C&No
❑ NA
❑ NE
12128104

N­ -Z
0' Visit 4D Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Pffier E] Denied Aocess.
Facility Number Date of Visit: Time:
BNot Operational 0 Bellow Threshold
Permitted & Certified 13 Conditionally Certified 0 Registered Date,Last Operated or Above Threshold:
FarmName: P7d e =_ 4A County:
JW ER
Owner Name: 'Phone No: _k_i 0) I's-
wiling Address: Eli
Facility Contact: __ -Title: Phone No:
OnsiteRepresentative: M­ z k.,jj.� a� Integrator. /Ore_A,_±a25. F-.-K"j
Certified Operator. •Operator Certification Number. -44
Location of Farm:
MSwine [3Poultry E]Cattle E]Horse Latitude 0 164 Longitude 0
D Caiitnt
Swine 6n=Ktv-ji6; On
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
P Gilts
Boors
Nimo�
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: [] Lagoon E] Spray Field [3 Other
a- If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaymin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is them evidence of 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?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ___L_
Freeboard (inches): 2 S
0 Yes No
0 Yes No
0 Yes [1) No
[I Yes
[I No
0 Yes
[3 No
❑ Yes
No
❑ Yes
jj No
Structure 6
12112103 Continued

Facility Number: — q? Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes P 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 maintenancefunprovement? ❑ Yes []3 No
8. Does any part of the waste management system other than waste st:ucMm require mainterrance/improvernent? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [ No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Rl No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 1P No
❑ Excessive Ponding ❑ PAN ❑ HydraulicOverload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Q� r w .��ct �% cs•� 1 b vG r s c c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes m No
b) Does the facility need a wettable acre determination? ❑ Yes [;�No
c)'This facility is pended for a wettable acre determination? ❑ Yes (A No
15. Does the receiving crop need improvement? M Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes P No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P 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 [;allo
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [�JNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes CINo
Air Quality representative immediately.
drav�uags aI_ y#a ti dam sitiris.(a3zl PaScsir'_). F Notes
_ _ Field Copy ❑ Final
se+thG G.�LtS b� i-�G Ln[7���G IOD� WC0.� 1h 5D4.--i GtCia-S.
Vr\or'.Are, r--4-'ts -'.1A -,V necCQ.
Reviewer/�/InSp..�.,eCtor Name�,,
Reviewer/Lmgxxtor Signature: hate: .1 3
12112103 i Cowed

Facility Number: — 2 C Date of Inspection ,U /
.
Required Records & Docnment-
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.} ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No
❑ Waste Application ® Freeboard ❑ Waste Analysis [Q Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
28. Does facility require a follow-up visit by same agency?
❑ Yes
®No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NJ No
NMES Permitted FacHities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
10 Yes
❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
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
No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
®No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
(p Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall q Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: A) 0
Facility No. Oat- a3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 1 7 , 1995
Farm Name/Owner: Pre 3
Time: ) ' 'IO
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2 � 2
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Mailing Address: PO 3 60$ �Nc.
County: - C3 ,<� c-z N
Integrator: •r+tc'.e Phone:
On Site Representative: Phone: ► - Gam- • 3��5
Physical Address/Location: 5 e.,.tt, of F --,'.,k '--` Z. +".1 rS
t.., .� r. ►.t e� 5 ►-t o{ Fes. Z +ti-1�
Type of Operation: Swine Poultry Cattle
Design Capacity: .D Number of Animals on Site: `7 S' -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) gr No Actual Freeboard:_L6LFt. Inches
Was any seepage observed from the lagoon(s)? Yes oro Was any erosion ob rved? Yes of�o
Is adequate land available for spray) Cam' or No Is the cover crop adequate? e or No
Crop(s) being utilized: -' d-t 3
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? es or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes o(!Y)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or19
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes'o(N� If Yes, Please Explain.
Does the facility maintain adequate waste management recoLk (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments: Feud T- • /,tv _
'NT L
OFFICE]
Inspector Name
... ��_ A�_
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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WORTH CAROLIM DI PARTMWT OF VIRONDWNT, HSALTH' b NATURAL R830DRGS.S
DMSION OF ENVIRONMM4TAL KANAGEKERT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
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All questions answered negatively Will be discussed in sufficient detail in
the - Comments Section to enable the deemed Permittee to perform the appropriate
corrections;
SECTION rr
Animal Operation : Fi-nrsh("n9
Horses, cattle, Swine poultry, or sheep
SECTION II
T I N I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with livid waste
systam)] .
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4- Does this facility have a CERTIFIED ANIIQL
WASTE MANAGEtgN'i PIJW.
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover Crop)?
6_ Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
JUL 31 I5•,
ENV MANAGEMENT
FAYETTEVI LE RE-U. OFFICE

� SN=OP
Field Site ManaSg eat
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Kay Slue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a DSGS Kap
Slue Line Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Dees the land application'site have a
cover crop in accordance'with the
C( RTIFICATZOl_VI.W
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
5. Does the animal waste management at this
farm adhere to Best Management Practices
(SMP) of the approved CSti'IFIQT -
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general condition of this CAF4 facility,
including management and operation,
satisfactory?
SMDN ry
90owts
I�'■j

w A.UMLAL W.LSTS HAHAC `F ZXT PLAN C3RT=PICAT=ON FOR NEW OR E=FA ZD FEZZLOTS
Please ratnxa the eempleted form to the Division of Saviroamaatai Vanagameat at
the address on the =evarae side of this fog. �.I.
Name of fans (Please print) : 7iRlAddress:— F-0. eb 7n 668
_ �L � �Tr�Fn a�,•l�, NG Z�S 3 3'7 Phone No o - M Z - .r
Coynty: a,1d _
Fa_-m location: Latitude and Longitude:Z' , /11 1 20" (rewire(j) . Also,
Please attach a copy of a county road map with location identifie;dd.
Type of operation (swine, layer, dairy, etc.):Shi.e
Design capacity (number of animals):
Average size of operation (12 month population avg.):
Average acreage needed for land application of waste (acres):
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Tsch=icai Specialist Certification
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to 1SA NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to iSA NCAC 2H.0217 and
1SA NCAC 6r .0001-.0005. The following elements and their corresponding minim=
criteria-ha=ebeen verified by me or other designated technical specialists -and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwate_ off events l�ee/� severe,than the 25-year, 24-hour
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'*PP �
Na=e of Technical Specialist (Please Print)
Affiliation: G�34� �✓RC
address (Agency) Phone No. 2-6
j� NC. lr337
Signature:(:::: * � G[J�tr---7 ��_ _ _ --- Date: � Z -r- p-d
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CwaerJvaaager Ag=aaaaat
I (we) understand the operation and maintenance procedures established in the
approved animal waste manage -meat plan for the fa--.m named above and will implement
these procedures. I (we) know that ary additional expansion to the existing
design capacity oL the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
=nviron*nental Manage -Went before the new animals are stocked. I (we) also
unders�and that there must be no discharge of animal waste from this system to
surface waters of the state either through a :Warn -made conveyance or through
rinofw from a storm event less severe than the 25-year, 24-hour storm. The
approved pla.-: ::ill !^e tiled at the farm and at the office of the local Soil and
'Hater Conseration District.
Na-a of Lead Ow=or (Please Print): GCr YQkjV j SSu Ip
Signature: Date: S Z
41
:7aWe of Hanagar, if different from owner (Please print):
Signature:
'.i4tQ: A change in land owner ship requiw es
(if the approved plan is changed) to
Environn-er_tal manage.-nent within 60 days o
Date:
nocification or a new certification
be submitted to the Division of
f a title transfer.
D74 USE ONLY:AC:I---W#