090130_INSPECTIONS_20171231

f
Type of visit: W Compliance Inspection U Operation Review U Structure Evaluation U 'I"echnical Assistance
Reason for Visit: QMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L J County:c 'l
Farm Name: �J 9�U 4 on.,_ Owner Email:
Owner Name: cJt WeA.- 6g�y � � Phone:
Mailing Address:
Physical Address:
Facility Contact: F1� -e Title:
Onsite Representative: f
Certified Operator: --fie 6 �ywt
Back-up Operator:
Integrator:
Region:`
Phone:
� &(x
Certification Number: �`C L
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine Gapacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Poultry
@a aci
P,o
Non -Da'
Farrow to Finish
iLayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
. her
TurkeyPoults
EFT ther
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[::]No
ErJ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ 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 DWQ)
[] Yes
❑ No
EEr<A
❑ 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
EffNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Ins ection: .
*Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l aX-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑,<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [R'lqo ❑ 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 [ io ❑ 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 [f4o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ffNo ❑ 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 [;-3No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [TNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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): ��LA 15(0O _.
13. Soil Type(s): tJ O )
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 [v]'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[EJ-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q'No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes
❑'No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑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 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facilfty Number: - Date of Ins ection: 277
.24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [tNo ❑ 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 Q No D 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
[21 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
03"'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
[!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
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[7f No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[/3rNo
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations. ;or any=ptheryommen6i {
Use drawings of facility to better explain situations (use additional pages as necessary).
Lf
ve-
q� q W1
� -�--jeA'VaV4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �3,3-333`
Date: 2,74 1b
21412011

L
IType of Visit: 5 CCo Hance Inspection O Operation Review Q Structure Evaluation p Technical AssistanceReason for Visit: Routine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: me Arrival Time: a?Etp Departure Time: J County:
Farm Name: Lu N1, - 9 ✓C,r" Owner Email:
Owner Name: if Phone:
Mailing Address: 54*,W- W 'lam hG'I%—
Physical Address:
'�+pRegion: !_
Facility Contact: K {C Title: Phone:
P ..�
Onsite Representative: t Integrator: �l
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Cnrrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
IDairy Cow
Wean to Feeder
by D
O
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
1D , Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
HPullets
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Turke s
Other
Turke Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I_34lo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[B<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3'1 ]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
[] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FaciligNumber: - Date of Inspection: 21
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
E]_Ue-_[] NA ❑ NE
❑ No � ❑ NE
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 e- ❑ 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
[f r llToo ❑ 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
ftN❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ ]dip ❑ 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
®Ko ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes a]�Mo ❑ 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): V ,,4.a
13. Soil Type(s): 6 oWJ •y'O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
12110
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[G]'Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;I -NZ
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea -,Kb—
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2'�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'1�10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes Q 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 do ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili. umber: - Date of Inspection: OG • - S
24.�Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Vj-?To ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes al5oT ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yese, ❑ NA ❑ NE
❑ Yes Eg-?4V— ❑ NA ❑ NE
❑ Yes D—o ❑ NA ❑ NE
[:]Yes ❑_bl4 ❑ NA ❑ NE
[:]Yes 2-P-o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
g le
❑ NA
❑ NE
[D>e
❑ NA
❑ NE
g-No
❑ NA
❑ NE
L2-K
❑ NA
❑ NE
Phone: tJ 3— 3Jy y
Date: "Al
21412014

type of visit: %!rUomphance inspection U Vperation Review U Structure Evaluation U I ecnnical Assistance
Reason for Visit: Q4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time; Departure Time: L2?= County: Region: I ZO
Farm Name: f (r, Wt E_At - Owner Email:
Owner Name: A4 y"' j- ' 'T Phone:
Mailing Address:
Physical Address:
Facility Contact: f �� 'I Title: Phone:
Onsite Representative: l( Integrator:
Certified Operator: ( _eat L G61 61 Certification Number: 7&� T
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design ;Current Design Current Design Current
Swine Ca aci Po Wet Paul Ca aci Po Cattle Ca aci Po .
fi y p t3 p• P h' p
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
fl
Non -Layer
Dairy Calf
Feeder to Finish
Design_ Current
Dr. P,oal Ca aci $oP.
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
INon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other _
Other
Turkeys
Turkey Poults
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
To
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ET5A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[2 1�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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[f]No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
To
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility N*umber:I - Date of Inspection:
Waste Collection & Trea ment
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 ❑-N-A ❑ 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 E '�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 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 t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
D 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
EfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
r
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2rNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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): `-jDai1""' - k
0
13. Soil Type(s): Iy
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
E o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
Rio
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WIIP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes
fNo
❑ NA
❑ NE
[—]Yes
0No
❑ NA
❑ NE
[:)Yes 60 ❑ NA ❑ NE
[:]Yes EfNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes FJ'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facitity Number: CY jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ lFo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ea<o
❑ 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
To
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] lZ
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes LY111U ❑NA ❑NE
D Yes E3 o ❑ NA ❑ NE
[] Yes [3 N'o ❑ NA ❑ NE
❑ Yes [aNo ❑ NA ❑ NE
❑ Yeso
❑ Yes [ No
❑ Yes [rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
comments (reler to question I;): Lxplain any YES answers!and/or; any aututional recommendaUons.or any. otner�commenW
Use drawingsof facili -.'to better explain situations use add �eoaal a es as necessary).
tY- p ( j -pages g .. .
��y� ram,,, � —;$^-- t
cgi 4
67
klt S
y
CkA h41 — o (ot Flay
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � � c333
Date: 21 41Lf
21412014

Type of Visit: C��ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e<o-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrivai Time: Departure Time:1� County: i�� L `1� Region:
Farm Name: 94dc&M, tip Owner Email:
Owner Name: W.,,f ee Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Represental
Certified Operator
Back-up Operator: E4e -e
Location of Farm:
Phone:
D
Integrator: 1. V .g Q
Certification Number: ZQ
Certification Number:
Latitude: Longitude:
Design Current "` vesigu Current Design Current
Swine Capacity Pop. Wet P�ouItiy Capacity Pop. Cattle Capacity Pop.
$
Wean to Finish
40
Layer
iNon-Layer I
"' -
Design Current
D $outtr Ca aei P.a P.
Layers
Non -Layers
Pullets
Turkeys
Turcey Poults
Other
Dai Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
ai Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
_
Other
Other
.-.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [fr-No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
(R A ❑ NE
[D'1lA ❑ NE
❑ Yes [:]No [g'IqA ❑ NE
[:]Yes [:]No EDoilA ❑ NE
❑ Yes Qo ❑ NA ❑ NE
21412011 Continued

Facili umber: -V jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes . No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3rl�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
El"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ej.-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E54o
❑ 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
L2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance aiternatives that need
❑ Yes
D-<o
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C 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): {1f ✓r't" > S 6 0
13. Soil Type(s): & f OrS ptp
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q'Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]'1\io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ 10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
l +�-Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Zj 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
EX
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
❑ Yes
�Z
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: Date of Ins ection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EKo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes <o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ 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 [jj<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [jKo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[]Yes
I No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3- o
❑ 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
[Ij-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
�io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E(No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
❑ NA
❑ NE
Comments, (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments,"
Use.drawifigs of facility to better:eaplain situations (use additional pages as necessary).
C'J ' 6'j
tf --3 - 13
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
. o ' 3.g'P, 9"7
P-J'rf o d._� ;�
Phone:llo 02"k —33s !
Date:
21412011

Type of Visit: &'Comp ' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Q; D'p Departure Time: County: Qom- Region:
Farm Name: ; �-�. �( �!1 /` Y Owner Email:
Owner Name: ,fie �. Ila rr�r r Phone:
Mailing Address:
Physical Address:
Facility Contact: A4 Xr-e Title:
Phone:
Ousite Representative: �j ._ Integrator:
Certified Operator:p��,r Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
by
Swine
Wean to Finish
Wean to Feeder
Design Current- rya'
Capacity PopJ
p
W4et Poultry
La er
Non -Layer
Design Current :
Capacty „Pop.
f
Design Current
C-attle Capacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Feeder to Finish
D . P.oul
n
Ca aci P,o
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [gNo ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
D Yes [:]No
[:]Yes L No
❑ Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

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

Facili Number: - Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CQ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Q_Yes fig,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: i/ 10 / a
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P. No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes C,No ❑ NA ❑ NE
❑ Yes � No
❑ Yes ® No
C] Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor'.any additional recommeadationsIorRany other comments " k
a,
Use drawings of facility to better explain situations (use additional. pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: h2 4,r)r— 33C�
Date:
21412011

- -Division of�Water Quality
Facility NumbeHvision oftSoil and WaterCanseevation
® Other Agency r
Type of Visit: Compliance Inspectioil Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4DI(outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: = Departure Time: ` p Y-1 County: t/
Farm Name: ` vL f /Vl/ejOwner Email:
Owner Name: a �� y Phone:
Mailing Address:
Physical Address:
Facility Contact:
•/ Title: cslcejn 7+A/` Phone:
Region: ellzd
Onsite Representative: �j��� Integrator: ��e',` 1 c3 9'—
If
Certified Operator: a2Lr1,..e, Certification Number: / 61;39-1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Ili'r Design Current
Swine Capacity Pop.
�
WetPaultry
Design C«urent i
Capacity Pop
�� 1 Design Current
Cattle Capacity Pop.
DairyCow
Wean to Finish
Layer
r
Wean to Feeder
Non -La er
DairyCalf
Feeder to FinishFarrow
� �
"t-"
DairyHeifer
to Wean
��$ ��
Design
Curr�ent�
D Cow
Farrow to Feeder
D *Poultry_ _
Ca aci
�Po �
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
m t'
Turkeys
Other
,Turkey Poults
�r
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes [g-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [�d_No [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4
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.)
DNA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 9 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Eq No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:)Yes
�&No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):G�-
13. Soil Type(s): �9r ji
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 O No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[&No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [.No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

_ Facility Number: - J w Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes a 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
n, fie" j
RNon-compliant sludge levels in any lagoon
�G-
List stmcture(s) and date of first survey indicating non-compliance:
(7— Q--
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 ® No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [gNo ❑ NA 0 NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes CR'No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or:any66ther comments3
Use drawings of facility to betfer,explain situations (use additional pages as necessary).:.
49§-aY ►�'+- l.[ 9 i { t h' IL � CU -�rl. &j D l�Jv , 7 r / I ��y�?r�i/
/[%G�r'• .' Z ; ,, , %D f= i a -5 .S70 ! / 3 L 4M �D C
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: x'leq
Date: 15_ Z��
21412011

s /v/�//C/ -)Z4-
Type of Visit Qt,om��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Di outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d(
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: d : Departure Time: County: Region: 1 40
Owner Email:
Phone:
Facility Contact: ._ !` 4w exf— Title: Phone No:
Onsite Representative: r Integrator: lof-41,
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= e [= I = Longitude: = n 0 t = u
Design Current
Design Current
Design Current
Swine C►apacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
ElNon-Dai
❑ Wean to Finish
❑ Layer
[gWean to Feeder (p0 4
3
❑ Non -La er
❑ Feeder to Finish
Dry Poultry
El Layers err
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Beef Stocker
err
❑ Gilts
❑ Beef Feeder
ElBeef Brood Cowl I
❑ Pullets
❑ Boars El
El Turkeys
Outer
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
❑ Yes +❑ Flo ❑ NA ❑ NE
❑ Yes
❑ No
ElNE
ElYes
❑ No
�EIA
ETNA
❑ NE
Ej<
ElN E
❑ Yes
No
❑ Yes
,❑
L�'No
❑ NA
❑ NE
❑ Yes
lL► N--O*
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
a. If yes, is waste level into the structural freeboard?
Facility Number: M — /,_30
El NA [I NE
[I NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: A20
Designed Freeboard (in): Z2 _
Observed Freeboard (in): -�
❑ Yes F& o
❑ Yes E #o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B 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 BNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L3 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
3<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
,_,/
Cl No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
U4o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r eL_ T
13. Soil type(s) _&Z T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[9 i�o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q-Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes r,�No El NA El NE
17. Does the facility lack adequate acreage for land application? El Yes Moo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ao ❑ NA ❑ NE
L
C �s � �-
7
Reviewer/inspector Name rT''*T'L* "*�T,'�'!► _ Phone: dW
Reviewer/inspector Sign re: _ Date: 16)db/D
Page 2 of 3 12/2$/04 ' Continued

Facility Number: Date of Inspection 4v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2-90 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Bf,lo ❑ NA ❑ NE
the appropriate box. ❑ V[Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' 'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fait to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
R<o
❑ NA
❑ NE
❑ Yes
0,Vo
❑ NA
❑ NE
❑ Yes
9'14o
❑ NA
❑ NE
❑ Yes
FTN' o
❑ NA
❑ NE
❑ Yes
Cl No
❑ NA
❑ NE
❑ Yes L'7 No ❑ NA ❑ NE
❑ Yes Q-Ko ❑ NA ❑ NE
❑ Yes [DQo ❑ NA ❑ NE
❑ Yes 09<o ❑ NA ❑ NE
❑ Yes [B No ❑ NA ❑ NE
El Yes E7No [I NA ❑NE
Page 3 of 3 12128104

-8X0-0%.5 /o -aq -zooq
Type of Visit QMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7-Q(% %-9 Arrival Time: //, 3r ,,/ Departure Time, %Z:. ya County: �14�j� Region:
Farm Name: Said ji ^j J3ro mcl, /r u E'Ye r c,, Owner Email:
Owner Name: / u4 iq /71(% t'de G Phone:
Mailing Address:
Physical Address:
Facility Contact: KGL4y1yGy�/_ _Title: �� -Sam Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = « Longitude: = o = A = 41
phi Design Current r ,.yDestgn Current s Design
`WetP,o 1
Current
Swtne Capacity Population a ty Capacrty Population Cattle ,l Capacity
Population
❑ Wean to Finish?
❑ La er
❑Dairy Cow
Wean to Feeder
1pQ
❑ Non-Laye! ❑Dairy Calf
, ..; ❑ Dairy Heifer
MI.jjrV Poultry , El Dry Cow
- ❑ Non -Dairy
❑ Layers
❑ Feeder to Finish
,�;_
❑ Farrow to Wean
❑ Farrow to Feeder;
❑ Farrow to Finish
❑ Beef Stocket
❑ Non -Layers
❑ Beef Feeder
El Pullets
❑ Gilts
❑ Boars
�
❑Beef Brood Co
❑ Turkeys :..
... ;..
Other
w
❑ Turkey Poults
Ej Otherarox.._��,.
❑ Other IP_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
��,�
L' NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
2'9A
❑ 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
ET5A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
ElE N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�[-�,o
Ld-/
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

(Facility Number: 09 — /30 Date of Inspection 7 04-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No
❑ NA
❑ NE
a. 1f yes, is waste level into the structural freeboard?
❑ Yes
io
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 2&
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElD Yes
o
❑ 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
B<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D<o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
�
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElYes
2<
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 13 A �,/
14, Do the receiving crops differ From those designated in the CAWMP? El Yes !� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes �, hio El NA El NE
17. Does the facility lack adequate acreage for land application? [I Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 31N. ❑ 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 /� /�/ G/ 1 ZW eJ S Phone:
Reviewer/inspector Signature: Date: '7- D% 7y6`7
12128104 Continued

. & 7-0y=7�y
Facility Number: 47 —/3p Date of Inspection 7—O
Rectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
F
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes lj No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B o ❑ 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
EING [1 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
//io
M o ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EKo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L3`No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LD11oo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo ❑ 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 ❑ 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
,_,
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
E34 ❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
L+I< ❑ NA
❑ NE
Comments andlor Drawings:
12128104

Type of Visit 606-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: tS.J� County:
Farm Name: ,(j&&4 !'z r/� 1" G�—ri.C� _ iU fir% Owner Email:
Owner Name: / �/r��'G �/3 CU Phone: _
Mailing Address:
Physical Address:
Facility Contact: /if67 Title: Phone No:
Onsite Representative: =!/ Integrator: —
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region: rR
Location of Farm: Latitude: EJ o E=I ' [--] " Longitude: = 0 = ' 0
Design Current Design Current
Design Current
Swine
Capacity Population Wet Poultry Capacity Populatiori
6 11 WCOapacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
I ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
D y Poultry
❑ D Cow
❑ Farrow to Feeder
El
❑ Farrow to 1' inish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Turkey Poults
❑ Other
Number of Structures: Ell
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9 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)?
71
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
19 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J,No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection dK
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:
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in): f_493
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 [9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes JR] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
�4 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[& No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA ❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > la% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Wind Drift ❑ Application Outside of
Area
/of
12. Crop type(s)
13. Soil type(s) Gm
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(SNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
R Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to yiestion #): Explain any'YES answers and/or any recomiiendations or any other comments.ij
Use drawings of facility to better explain situations. (use additional pages as necessary):
' g„
r r hv-c 6v-r"s
Reviewer/Inspector Name j
�'�` �� Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: 1-1301 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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 5kNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fA No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
54 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency`?
❑ Yes
E& No
❑ NA
❑ NE
Additional Comments and/or Drawings I; �it M
Page 3 of 3 12128104
Page 3 of 3 12128104

f
MI
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation : =��
v
O Other Agency
Type of Visit ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1® Arrival Time: O Departure Time: �� County: ems— Region:
Farm Name: l. ,A`r+.-- IrA-�-�� trS Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r I AEft t Title: Phone No:
Onsite Representative: �G`�--� Integrator: 4 9C
Certified Operator: �_"" Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ r = {6 Longitude: ❑ ° ❑ 6 =
it
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder 081D to
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 01,
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 19 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

I
Facility Number: — Date of Inspection
'f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes t@ 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): .35-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (3 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CgNo ❑ 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 M No [:1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need ❑ Yes t4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes r�UXL'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
l2. Crop types) U r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? JZI Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ 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):
F�at` ��rdl�s
�Ul� ype-of� 3, � ile�es��45� �5 i �jo/'c—
Reviewer/Inspector Name
v & Phone:
Reviewer/inspector Signature:
Date:
12128104 Continued

0
Facility Number: — 3 Date of Inspection
Required Records & Documents
l9. 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 0 No ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking O Crop Yield ❑ 120 Minute Inspections 5d Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JR No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
09 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[HNo
❑ 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
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
C No
❑ NA
❑ NE
Additional Comments andlor Drawings:
At. f'(erj crVfX)Aj_.S e-7- 1pu.r- Faro, r�cB S
12128104

Type of Visit CCommpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 04'0utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
[��
Date of Visit: �� Arrival Time: .',3 Ur `Departure Time: %v2 r ,�'� County: Region:
Farm Name: �Qi LUi +^- B_I"'L je'jj- Alo"-S5 r7 ____ _ Owner Email:
Owner Name: XA ZiinyC Ma,,d� Z C', L / Phone:
Mailing Address:
Physical Address: /
Facility Contact: Ma-7 Y _ Title:
Onsite Representative:v�--
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: �✓/�'s7 7t
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' [—] „ Longitude: = o =' E—] „
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�!❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Ileifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z. No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — / a
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:
Spillway?:
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 KNo ❑ NA ❑ NE
❑ Yes 91 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes P4 No ❑ NA ❑ NE
El Yes 54No El 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? Kyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [4 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 EQ No ❑ NA ❑ NE
maintenance/improvement?
_ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind Drift ❑ Application Outside of Area
12. Crop type(s)t�.r'/�1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW'MP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes CONo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
cum c� 0--k- xyw->�
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes JRNo ❑ NA ❑ NE
Reviewer/Inspector Name '.+fal �, i1+ Phone:
ReviewerllnspectorSignature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes IgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EffNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
154No
❑ NA
❑ NI?
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
ES No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C.No
❑ NA
❑ NE
Page 3 of 3 12128104

— Division of Water Quality
Facility Number Division of So- and Water Conservation
Q Other Agency
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Z 0. Arrival'i'ime: Departure Time: County: Region:
Farm Name: s�i:... �A /V +Nm.t�-� _ Owner Email:
..�11 ��— DD �. -- {
Owner Name: _ _ l7A.t`d�?P _ c�Jt Phone:
�1 � h
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1L�-{�.��jLa CA .vim
Certified Operator: • T�o-tl ti S Jl�rat PG'
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: ZZ'J�7
Back-up Certification Number:
Latitude: ❑ o = ` [=] Longitude: = ° ❑ ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
!a 0 $O I 8 l O---f 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turket
❑ Turkeints
❑ Other
Discharp,o & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current!_:, .
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: ETLl�
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 5�No ❑ NA ❑ NE
❑ Yes
❑ No
[ANA
❑ NE
❑ Yes
❑ No
9LNA
❑ NE
kl§ NA
❑ NE
❑ Yes
❑ No
[:]Yes
®,No
❑ NA
❑ NE
❑ Yes
0.No
❑ NA
❑ NE
12128104 Continued

Faciliiy'Number: -
Date of Inspection 0 bi
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 F Structure 2 Structure 3
Identifier: A�
Spillway?:
Designed Freeboard (in): -54
Observed Freeboard (in): W
Structure 4
❑ Yes JZ No
❑ Yes ❑ No
Structure 5
El NA El NE
[LNA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E?,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 KNo ❑ 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 R�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes © No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C ! No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
nn a �a�)
12. Crop type(s) lea. kart U �- 14�c , S�ca,(r� .v
13. Soil type(s) C� t 64
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EgNO ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
QQVo
Cl NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
,gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5.No
❑ NA
❑ NE
f Reviewer/inspector Name_—� Phone: f - W5- zZ
IReviewer/Inspector Signature: �� ,, -' Date: t101 0,6 /as:
12128104 Continued

,facility Number: — j Date of Inspection iloakl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. B Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking KCropYield ❑ 120 Minute inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[fNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[9NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[5�No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§9 No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(SNo
❑ 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
[ffNo
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA ❑ NE
12128104

[Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number `� �, Date of visit: %//d5 6 Time:
Q Not 2grational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: 1 a2 tom; f o (A- t~ rs c County: Q FP-o
Owner Name: _�"? S t�� r t C�z w- 1 Phone No: Ci ca� ;!S- Zi O 3 9
Mailing Address:.._ 3�� . �.�5�.1 tia�� ��^� � :..r _� _ _ � � ; t� b �i �. �-o _,�,� } At C- .?. _ .33 z ...
Facility Contact: _ . __ _......_.. __ __ Title:.........._... p .,,,__ Phone No: .. _ .
Onsite Representative: ---- -- � Q �� cog a & _ -_ Integrator. 1 n c. s4
Certified Operator.— ------- ----- - ZA2 r a xbp Operator Certification Number:
Location of Farm:
M Swine © Poultry ❑ Cattle ❑ horse Latitude • Longitude • '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin? Al /14
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ANo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes [� No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): 7 ��
12/12M3 Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance!improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
0 Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type A-'7/V-14
/ /`
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNT)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c)'Ihi.s facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
I6. is there a lack of adequate waste application equipment?
❑ Copper and/or Zinc
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
10 A e 1, e
-A, t edr
y-4 G'N k'� CAL Qt1 SA''-;+%r�t11
'-C f'R e
�W L17 4Yl dt � tY� l l
4-kc- �C
Anotl.t-
WbdRS i T 1, 'CV= c=4
sewte- j.. Sa4 -a4c,,Q
/r'n+r, +t1c7 1«4-< ' 6c_+,
t^C• r y4,
98L I i 4�_-
❑ Yes No
❑ Yes No
❑ Yes 1P No
❑ Yes [% No
❑ Yes P No
❑ Yes ® No
M Yes ❑ No
[:1 Yes 09 No
❑ Yes ]A No
❑ Yes IV No
❑ Yes ® No
5J Yes ❑ No
❑ Yes W No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes 19 No
Field Copy O Final Notes
" n -k-�..- R'.,SA -9 , ccto:cs
i-'X -e-6 CL a a � � � G 14 •. � 1
c,"u-+4�-FL{T t�oj. i� inoiv
its0, L':it � aN IN yGirlMf9 4-o Pra.P - +�.c
Ca,J ,;V4 leak tke, wC.to
h e c U r" co 0 I\ o
doC-�G� 4 ►�p� nj 21i, l r e.t^I- to n, preJ b �tr.ke��
Reviewedlnspector Name
Arco Ur, PC, ,A.
`i ,, C_ <
Reviewerllnspector Signature:
12/I2/03
Date:
Continued

facility —Number: Date of Inspection jj1Z
Reauired Records & Document,-
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?
(it/ WUP, checklists, design, maps, etc.) ❑ Yes P No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PO No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ 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/fnspector fail to discuss review,iinspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
[Z Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
09 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
❑ Yes
JQ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

FacilityNwnber:.Pj_- 130
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date-
GenerAl Information,
Farm d - Qx County:_ gI a je .
OwnerName: f r lo` L.r Aeer _ _ Phone No,-- ' F6 a 3IK
On Site Representative: (1e�- C ,ffoo _ .�.. Integrator. re s-{a-q-a,
Mailing Address: EQ. 6o-x 1 '-T (. _
Physical AddresslLocation:�,. ��'., QI w,n ro r-w �� c 52tdo 3
Latitude:�Longitude:.OlDl I
eration Description:. (based on design characteristics)
Type of Swim No. of Animals. Type of Poultry No. of Animals Type of Cattle No. of Animals
O Sow O Layer O Dairy
* Nursery ❑ Non -Layer O Beef
❑ F;mft
OtherTjpeoflivoes=lr �d4 -'e wer..4 Number of Animals: /a7S
Namber of Lagoons' (include in the Drawings and Observations the freeboard of each lagoon) '
Faciffily Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?.
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
O Man-made Q Not Alan -made
Cover Crop '
Does the facility need more acreage for spraying?. -
Does the cover crop need improvement?.-
( list the crops which need imprmvemenr)
Crop type: Acreage. 7
Setback Criteria
Is a dwelling located within 200 feet of waste application?
- Is a well located within 100 feet of wasti4pplicatioa?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI - ,TanneryI7JM
Yes 0
No;K
Yes ❑
Now
Yes ML
-No
Yes O
No 19
Yes 0
No t5k�
Yes,V
No Q
Yes O
No M -
Yes U
.-,No$b-
Yes D
Now
Yes ❑
Now

Maintenance
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Explain any Yes
Yes 0
Npb[-,>
Yes 0
N)),W
Yes ❑
No 0
Yes 0
No 0
_ If Ct ems - �' cr �4-�C C _ i o P i S r`,� e e i' �r ¢U At [ 5y _ tN - —, J2 so.,-
s t3� �cr�goa� t�vRG �� d�xaid
$ignati,
cc Fac ityAssesmera Unit . - Use Ail"A ents;fNeeded
Drawings or, _Observ_atioM:
-Ceo
. -- -t:� Lf�_.._�.r.r� y�. - '.r— - _._ - _ ..- �'r��e•�e..�i r,.nr �w�,..i+•,n +�'s1•��e1�' ,,;..�� l.��n��w.r�{.-�.-�q �r'w�:•- +-"ss-.:
i„�4_f • :.� ..' f - • - - - :T+:%;':-�ej^���. �;:'-.ieYiii "J�' :�'� !?['�'i'x J?+r;•:•�-ii�w L`.,�-:- •- • - -
AOI — January 17,1996

Facility Number. Qc%- 3 O
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Time: .
General Infornr-atiow
Farm Name:. SCXf :,., ry ;►•3�.aNci, ll�u vs e r CrH�+ Mari« Fa.�y; _$�Q��
Owner Name: h/i a� + N a r d « ti rle No;(9 i o) gb Z - 83 J
On Site Representative: 4 w nr car _Integrator: _ P rF4,
Mar7r'ng Address: P O Mcr-C IS 7
Al c z8337
Physical Addressft ocatiaa:
Latitude: Longitude:
Lon itude• I_�I
Operation Description* (based on design cbaracterisft)
Type of Swine No. of Animals. 7jpe of Poultry No. of Anhnak Type of Cottle No. of Animak
o son► o L 0 Dairy
Franey (00,90 0 Non -Layer 0 Baf
0 Feeder
Otherroe of LhwsxcL-Nwnber of Animcb.
Ntimber of Lagoons: i (include in the Drawings and Observations the fiwboard of each lagoon)
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the. lagoon?:
Is erasion observed?:
Is any discharge observed?
Q Man-na:de Q Not Mhalmode
Cover Crop
Does the facility need more acreage for spraying?:
L
Does the cover crop need improvemeW.-
(Aa the crops which need &npro c)
CPV A
te' -- - Setback Crtteda -
C3 ft �) Yeso Naar'
Is a dweMng located within 200 fed of waste application?
- Is a well located within 100 feet of waste applic adm?
U animal waste stockpiled within 100 feat of USGS Blue Line Stream?
Is animal wash land applied or spray irrigated within 25 feet of Blue Linz Stream?
AOI January I7p%
Yes O
No 0"
Yes 0
-No 0r
Yes 0
No O,
Yes 0
No Cr-'O'
Yes 0
No 0'
Yes 0
No -
_
Yes 0
No %sue
Yes 0
No Q�
Yes O
No Q�

Maintenance �
Does the facility maintenance need impmvement? Yes 0 No M-
Ls there evidence of past discharge from any part of the operation? Yes O No M-'
Does record keeping need improvement? Yes 0 No
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes O No
C,,v4. A/ 000-7 o3
Explain any Yes answers, _ A/a �.. c-f a.y5 `d �6 _ �a �� cAQ. _d
RL-t6C s-C— c U 3-- 9- F� Z 3 z
Sim Date:
cc FbaftyAssespnew Unk .. UseAnrackne„U if Needed
Drawings or hervadmg-.
_j nyr..�...r y. — -.c - .-.._ - �•+x+e�e••�.rr...• ��4srro Y,.a +at1'Ffw� w+`i•�j •-�:rrll�'�7+.. �lr._•-iws
AOI — Jannar717M%

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Matt Hardee
Matt Hardee Farm
P.O. Box 1576
Elizabethtown NC 28337
SUBJECT: Operator In Charge Designation
Facility: Matt Hardee Farm
Facility ID#: 9-130
Bladen County
Dear Mr. Hardee:
n"EC PVT©
NOV 19 1996
FAY i as EA, F1L'l lr
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997, The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sincerely,
A. Preston Howard, Jr., P.E., or
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, 4k 4 FAX [phone]
Raleigh, North Carolina 2761 1-7687 N )04'c An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50°,6 recycled/ 10% post -consumer paper