090132_INSPECTIONS_20171231

Structure Evaluation Inspection . .
Facility Number: t. Date: / x— J $
Time in: 1l ;3V Time-out:
Farm Name: J�(-rec MOc)e, Farm 911 address:
Owner Name: to<c Phone
Facility Contact:
Onsite Representative: Integrator:
Certified Operator: Cert. Number
Is storage capacity less than adequate? Yes./ No
If yes is waste level into the structural freeboard? Yes No Was non-compliant level reported to DWR S POA received
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.): f . /
Observed Freeboard (in.): r;Zy /y
Are there any immediate threats to the integrity of any of the structures
observed? Yes No •
Do any structures lack adequate markers as required by the permit? Yes No
Does any part of the waste.management system need repair Yes No
Condition of field's iJ
Condition of receiving crop. I—a.54czo( pa
Comments: •
1

Division of Water Resources
Facility Number] - a Division of Soil and Water Conservation
"O ,Other Agency
Type of Visit: ffCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! / Arrival Time: ; pC] Departure Time: ; DQ County: � Region: lafp
Farm Name: '%r7r/"Gx /Vj%ll Owner Email:
Owner Name: ,�(f;-Zf ; �'_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Q Cori Phone: /
Onsite Representative: ` ��—� _ Integrator: ��• ��'J
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design
Swine Capacity Pap. Vet Poultry _ Capac ty
Wean to Finish La er
Current
P©p.
Cattle
Dai Cow
airy Calf
airy Heifer
D Cow
Design Current
Capacity Pap.
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , P,oul Csa aci
La ers
Non -La ers
Current
P,o
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
other
L_L2Lher
Discharges and Stream Imnacts
I . Is any discharge observed from any part of the operation?
❑ Yes
ENo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
[-]Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[-]Yes
[KNo
❑ NA
❑ NE
of the State other than from a discharge?
Page ! of 3 21412015 Continued

Facili Number: - Date of Ins ection:
-� d
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
]f'No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6'
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): S{�G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P-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
ULNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)=
13. Soil Type(s): 'if E�x 14 / 2&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes La No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
[] NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Pa 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 allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZNo ❑ NA ❑ NE
Page 2 of 3 21412015 Condnued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ®. No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes S No ❑ NA ❑ N E
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
RNo
❑ 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
Callo
❑ 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
�o
❑ 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
EO-No
❑ NA
❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej�.No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
[H-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eg!No
❑ NA
❑ NE
o
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

u
(Type of Visit: (ZO'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: • C p Departure Time: L_! County: Region:
Farm Name: _ rr'CZ` /yQ�C� Owner Email:
Owner Name: �l!J ; `� i z���.� Phone:
Mailing Address:
Physical Address:
Facility Contact: jy) fli e7- Title:
Onsite Representative: s`r_
Phone:
Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current '" Design Current
Swine
Capacity
Pop4w Wet P©ultry
Capacity
I'op'Cattlei
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
3j�7
Layer
Non -La er
w.
b�
,.. 1),, Point .
Design
Ca aci.
Current
1'a
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Gilts
La ers
; Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
other
Turkey Poults
."
Other
Other
Discharizes and Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
JRNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
_0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RLNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ES.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in): / g
Observed Freeboard (in): 3 ;2— 31r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®.No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(Z 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 allo ❑ 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): ^Z25r 711�
13. Soil Type(s): 4 R/..y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q 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?
Reuuired Records & Documents
❑ Yes EQ No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑Wi1P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes. check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
12 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�qNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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, aver -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 f5Z�No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [`No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA [] NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[l No
❑ NA
❑ NE
[::]Yes
E�-No
❑ NA
❑ NE
Comments {refer to qu��on #��E pliin any YES answers and/or. anyma onaE�teecommendations or. any ot}�er"comments.M7-,-
Use drawin s of tggbetter ea _fam'stuatiogs use additional l ry}.�';
!a h#to_ P._ ( ,pages= innecessa.- ' s
Reviewer/Inspector Name-
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 1eq-3D3 O r3"!
Date:
214120I5

iJ 0 V . g01L,-pC--
'5�c- 3-4w5 �rG
t ype of Visit: U Compliance Inspection V Operation Review U Structure Evaluation (.) Technical Assistance
Reason for Visit_ Routine p Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: j, Arrival Time: '3a Departure Time: ! County:
Farm Name: _ _:Rr/�2- �'0aa _ Owner Email:
Owner Name: _1,4j�/(; t_- I- „$�- p�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Gil;/�,'� z,"v/ Title: Phone:
Region: ,. b
Onsite Representative: Integrator: r,K,
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Cnrrent
Design Current
Swore ..
Capacity Pop.
Wet Poultry
Capacity
Pop.
Ca#tle Capacity Pop.
Wean to Finish
La er
Da' Cow
Daig Calf
Wean to Feeder
Non -La er
G%
--�
...
-
Feeder to Finish
Dairy Heifer
Farrow to Wean
en
Dry Cow
Farrow to Feeder
D P,oul "
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:
Turkeys
_ .-...._..
Other_ ' "� ;;
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
[:]Yes allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes No
[:]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

• Facili Number: a - Date of lns ection:
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 I Structure 2 Structure 3 Structure 4 Structure 5
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.)
[:)No DNA ❑NE
❑No ❑NA ❑NE
Structure 6
[] Yes �D No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
10 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify
DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
JoNo
❑ 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
JZ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
jo No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):�r/� _
l4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 4E No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes (2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes allo ❑ 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'M 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 21412014 Continued

Facili Number: - ,3 Date of Ins ection:/6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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)
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
S No
❑ NA
❑ NE
es as necessa:
110061_4 pur
j � f
Reviewcr/Inspector Name: '�_r.-I-- ASP
Reviewer/Inspector Signature: Date: S /�
Page 3 of 3 V412014

1� -,-6Zo-rj , ;Z -,;?7-1 L, -3 o 6 �--
' PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: q - /3,�- County: 616j*-A
Facility Name: eIrlanova-
Certified Operator Name: i lie- Operator #
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Lagoon Name/identifier (ID): 1__ 2-
Spillway (Yes or No):
Level (inches).
2. Check all applicable items
rl D PLO
145
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Quality prior to transfer of waste
to a site not covered in the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, {provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: IN
I hereby certify that I have reviewed the information listed above and included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
Facility Owner/Manager (print)
Facility Owner/Manager (signature)
Phone: qio- 5U- 3`749
Date: -Z I Z(P III,
7�
PoA Cover Page 2/21/00

ti
li. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YRJ24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1. Structure ID: Terranova 1 line m =
248.7 lb PAN
2. Structure ID: Terranova 2 line m =
161.8 lb PAN
3. Structure ID: line m =
lb PAN
4. Structure ID: fine m =
lb PAN
5. Structure ID: line m =
lb PAN
6. Structure ID: line m =
lb PAN
n.lines 1+2+3+4+5+g=
410.5lbPAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD. DO NOT LIST FIELDS TO WHICH PAN CANNOT BE APPLIED DURING THIS 30
DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining ERR
2 PAN balance
(lb/acre)
t TOTAL PAN
BALANCE FOR
FIELD (Ibs.)
column r x s
u. application
window'
T8197
1A,1C
matua
0.80
45.33
36.4
Oct -Mar
T8197
1113,113,11N,110
matua
1.61
40.76
65.5
Oct -Mar
T8197
1 E,1 F
matua
1.48
59.92
88.9
Oct -Mar
T8197
1 G
matua
0.74
58.73
43.6
Oct -Mar
T8197
1H,11,1J,1K,1L
,1 M
matua
5.19
51.54
267.7
Oct -Mar
T8197
2A,2B,2C,2D
matua
1.61
45.33
72.9
Oct -Mar
T8197
2E, 2F
matua
1.48
51.51
76.4
Oct -Mar
T8197
2G,2H,2J
matua
1.11
37.00
41.1
Oct -Mar
T8197
21
matua
0.74
51.54
38.2
Oct -Mar
T8197
2K
matua
0.56
38.90
21.8
Oct -Mar
T8197
3A-3E
matua
1.00
23.51
23.5
Oct -Mar
T8197
3F, 3G, 3J,3K,
3L, 3N
matua
2.85
37.00
105.4
Oct -Mar
T8197
31-11, 31
matua
1.02
29.941
30.7
Oct -Mar
T8197
310,30
matua
0.6,31
36.68
24.9
Oct -Mar
'State current crop ending application date or next crop application beginning date for available
receiving crops during 30 day draw down period.
v. Total PAN available for all fields (sum of column t) = 937.1 Ib. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) = 410.5 Ib. PAN
x. Crop's remaining PAN balance (line v from section Ili) = 937.1 lb. PAN
y. Overall PAN balance (w - x) _ -527 lb. PAN
NARRATIVE:
Will begin pumping as soon as field conditions permit.
PoA (30 Day) 2/21100

ti
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
1. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/identifier (ID): ITerranova 1
2_ Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker 16.0 inches
b. designed 25 yr./24 hr. storm & structural freeboard 19.0 inches
c. line b - line a (inches in red zone) = 1.0 inches
d. top of dike surface area according to design
(area at below structural freeboard elevation) 88796 ft2
e. line c/12 x line d x 7.48 gallonsW 42883 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design 80705 ft3
h. current herd # 2448 certified herd #1 2 448
actual waste produced = current herd # x line g = 80705 ft3
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 days/line f-
4. Total PAN to be land applied during draw down period
I_ current waste analysis dated 1 12131TO15
m. ((tines e + k)11000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
®ft3
42000 1ft3
152972 gallons
1.27 Ibs/1000 gal.
248.7 Ibs_ PAN
PoA (30 Day) 2/21/00

I
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1_ Structure Name/ldentifier (113): 1 Terranova 2
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker I 18.0inches
b. designed 25 yr./24 hr. storm & structural freeboard I 19.0 inches
c. line b - line a (inches in red zone) = 1.0 inches
d. top of dike surface area according to design
(area at below structural freeboard elevation) 43798 f?
e. line c/12 x line d x 7.48 gallons/W 27301 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design 403521 ft3
h. current herd # 1224 certified herd #1 1224
actual waste produced = current herd # x line g = 40352 ft3
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 daystline f=
4. Total PAN to be land applied during draw down period
I. current waste analysis dated 12/3112015
m_ ((lines e + k)/1000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
1 W
27253 ft3
84281 gallons
1.45 Ibs/1000 gal.
161.8 lbs. PAN
PoA (30 Day) 2/21/00

f
.17
i ype ut visit; vycumpnance tnspecuon V vperaaun xeview u btructure Gvaiumuun V i ecnmcai Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency () Other O Denied Access
Date of Visit: 59�
Arrival Time:
Departure Time: ,'_3 a
County:
Farm Name:
rr 1J py,;L,
Owner Email:
Owner Name:
!i(�� y�`t L ,-2wd
a
_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 6Uabr Title:4QUin evl­ Phone:
Onsite Representative: Integrator:
Certified Operator: S71_9o�_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region: MD
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattie
Capacity Pop.
Wean to Finish
La er
Cow
Wean to Feeder
Non -La er
E=1Da
Da' Calf
Feeder to Finish
(�
fJa
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D P,oul
'a aci
Pao
Non-Da'Iry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turke s
EC::ejr
Turke Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes Wo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [—]No
❑ Yes ® No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Dg-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): jt�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
to 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
R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ 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): / ct / %%%'ocm /&
13. Soil Type(s): X J¢ 4 y,3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes t@ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[8 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[K 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 ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes MNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [g No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
.I
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes Wo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes PLNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Callo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®, No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[g 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
MNo
❑ 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
IN No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J,No
0 NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CffNo
❑ NA
❑ NE
Comments (refer to question.Explain any YES answersand/or any addionalrecommendatious orany,ather comments. h
... ... ,.. - ... ,�- .. '� ,�.: ..,
Use drawings -of facility to better ea lam srttahons' use, additional pages as necessa ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: gKomptiance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /'3 County: w Region:
Farm Name: 7�;- rl-a N fpUcL Owner Email:
Owner Name: W ; It ; � L �r—d r� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: , S�..e1
Back-up Operator:
Location of Farm:
Integrator: r /)wk—
Certification Number: A"'x7 /
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
b
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . A ul u
Ca ci
P,o -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
I
lother
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑ No
[:]Yes [:)No
[:]Yes RNo
[:]Yes [Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IFacili Number: Date of inspection: ff`
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QSNo ❑ 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): / ej
Observed Freeboard (in): AL3-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CZ 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
,PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JEg-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): A'4.- 11
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[EINo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
th No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rVI V':f 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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes El No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [K No ❑ NA ❑ NE
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
g No
❑ NA
❑ NE
[—]Yes
[RNo
❑ NA
❑ NE
❑ Yes
Z] No
❑ NA
❑ NE
❑ Yes fa No ❑ NA ❑ NE
❑ Yes fNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:)Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
D�LNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
5c No
❑ NA
❑ NE
Comments (refer to yuestton_#)Explain any. -,YES answers and/or any additional recommetidations.or any other comments:
Uge;dfawhigs of facility to better explain.`situations (use additional pages as necessary).
evv�)Wle XOYA—�q- e"tp""
Reviewerllnspector Name: f ` -nVe
Reviewer/Inspector Signature:
7
Page 3 of 3
Phone: l�
Date:
21412011

M
Type of Visit: WoGmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 046'atine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 12EjE� Arrival Time: '. Q Departure Time: 0 County: .r Region:
Farm Name: tt D Owner Email:
Owner Name: ter I ��a rp� Phone:
Mailing Address:
Physical Address:
Facility Contact: f/�� j j 7 ��, ,,� Title: c9l�f7 Y r/
7 _
Integrator: v✓ /3rvW'\_
Certification Number:
Onsite Representative: _jr—�
Certified Operator: K�„rl
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
' 4I
Desp 5a rent
Design Current
Swine
Capacity Pop.
Wet !UItrr.yapacEtyPop.
�e
Cattle Capacity Pnp.
Wean to Finish
La er
Da Cow
Wean to Feeder
Non -La er
airy Calf
eeder to Finish
h
Da' Heifer
Farrow to Wean
.l?esagnCurrent
Cow
Farrow to Feeder
Farrow to Finish
D . P■oul .
Layers
G_ a act �Po .
Non -Dairy
Beef Stocker
Gilts
Boars
-
Non -Layers
Pullets
Turke s
Beef Feeder
Beef Brood Cow
Uther
Other
_
Turke Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes [No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:)Yes ❑ No DNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
C] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

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

Facili Number: 7 - / LK 1 jDate of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes [ -No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pemmt? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
Comments (refer to q estion #): Explain any YES answers: and/or: any additional recommendations'or;any other'comments.
Use d5911
rawMgs off r
f facility to.better.explain situations.(use additional pages as necessary).;"
Reviewer/Inspector Name: rl/� .�� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

.t
Date of Visit: _L:E rrival Time: Departure Time: /lam County: rw Region:
Farm Name: ���r-u A/C V a Owner Email:
Owner Name: �j(f , r r l, , 5 e r�� Phone:
Mailing Address:
Physical Address:
Facility Contact: �/(% - Title: Phone:
Onsite Representative: �'�� Integrator: Wz4"-Q4e
Certified Operator: ��� � Certification Number: Zia zz /
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Curren#
Swine Capacity Pop.
Vet Poultry
Capacit}'
Pop,
Cattle Capacity Pop.
Wean to Finish
i
Wean to Feeder
Feeder to Finish
La er
Non -La er
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oultry
Ca achy
P-71,
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow.
Other
Turkey Poults
Other =WtOther
DischarL-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R[ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5K[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
'ice No
❑ NA
❑ NE
a. lfyes, is waste level into the structural freeboard?
0 Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % 9 j
Observed Freeboard (in): V9_ 9-11"_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[M 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
r'71 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
Ig No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z No
[DNA
❑ 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
4No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):6 ,ZZ7,2Z,12A
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
S—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LqNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
El No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes &No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilit • Number: - Date of Inspection:
,I 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 J [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes X[ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z[ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JKLNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes .P9-No ❑ NA ❑ NE
❑ Yes > No
❑ Yes &No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Cotnments.(refer to question # Explain any YES answers and/or any addtttohifF ommendations orany other comments:
Use dra►►•ings of facility to better explain situations (use additional pages as,necessary)Rk
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit U-Compliance Inspection ()Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � County: Region:
Farm Name: Jj Owner Email:
Owner Name: ` 't C— Phone:
Mailing Address:
Physical Address:
Facility Contact: — W % 1 i e _ Title: Lji'? X'2L Phone No:
Onsite Representative: 57151�_ Integrator: u✓
Certified Operator: S'd--�-�— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = u Longitude: = n = 4 0 4i
Design Current
Swine Capacity Population
Des1gao C>urrent Design
Wet Poultryr Capacity Population Cattle Capacity
C*urre it
Population
❑ Wean to Finish
❑ Layer
❑Dairy Cow
airy Calf
❑ Wean to Feeder
❑ Non -Layer j
eerier to Finish 3 `Z -enpa z
❑ Farrow to Wean D Poult
❑ Farrow to Feeder
El Farrow to Finish [3La Layers
Gilts ❑ Non -Layers
Pullets
EBoars El P
❑ Turkeys
Other ❑ Turkey Poults
❑ Dairy Heifer
❑ Dry Cow
Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Other ❑ Other
Discharees & Stream Impacts
I - Is any discharge observed from any part of the operation?
❑ Yes
nCNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C�-No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —.1,14 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
29No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: !}—
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): �� 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
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?
C&Yes
RtNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PkNo
❑ 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
25-No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J2LNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) / r
13. Soil type(s)��� y� T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EINo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
J4 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
Reviewer/inspector NameA Phone:33aQ
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Eallo ❑ NA ❑ NE
the approprrate box.
❑ WUP El Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O,jdo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
23-No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J,No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
0,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
N_No
❑ NA
❑ NE
Prd;.,,T-,,- Lt
Page 3 of 3 12128104

A
Type of Visit Otompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &.1toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �+--•6��--, Arrival Time: Departure "time: ; (jC7 County: Region: / R0
Farm Name: Tir i e a U x� � Owner Email:
Owner Name: W r I I rd p2i/ Phone:
Mailing Address:
Physical Address:
Facility Contact: If , K7 Title: Phone No -
Onsite Representative: Integrator: _ ZLa�tzl ..
Certified Operator:y�lc�--r Operator Certification Number:
Back -up Operator: Back-up Certification 'Number:
Location of Farm: Latitude: ❑o =1 ❑u Longitude- ❑o =1 =U
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I ❑ Non -Layer I T_�]
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DgV Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EQ
b. Did the discharge reach waters of the State? (If ves, 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 QE�AIo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE'
❑ Yes
G!�Afo
❑ NA
❑ NE
12128104 Continued

1
r Facility Number: — Date of Inspection
Write Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Stnicture 2 Structure 3 Stnicture 4
Identifier. -
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (iny
❑ Yes 59No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D9 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
J9 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?
19 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
No
❑ NA El 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
19 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JKNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JRNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
, ❑ Yes
RLNo
❑ 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
RLNo
❑ 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):
wo
r' use y1�)
a
Reviewer/inspector Name Phone: 52�,73—,33ufl
r—
Reviewer/Inspector Signature: Date: / '-/D
!6/Lo/V9 C,On1j""Cu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box. ❑ VIUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tZ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® 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
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JO No
❑ NA
❑ NE
12128104

r
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation [�
- — - Q Other Agency
Type of Visit
ompliance Inspection
Q Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: �i 3 Departure Time: �� County: �'�- Region: r�
Farm Name: Kin 1.42 Owner Email:
Owner Name: _ W 1 l t rzff 'ffr1z 7/ Phone:
Mailing Address:
Physical Address:
Facility Contact: �i(/ _i ��ar Title:
Onsite Representative:
Certified Operator: _5:��
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
Phone
No:
Integrator: zgf"
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= 4 Longitude: 0 0[= t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_, ❑ La er
❑Non -La etI _d:
LJ Boars { E
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
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)?
Number of Structures:
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[:]Yes
❑ No
❑ Yes
2"N'o
❑ NA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
es
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
EK
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D<o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
�,
M-K.
❑ 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-rTo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E 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
ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RK
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L1No ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) '5e7" . a-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
U No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
h'b► &,,,5 -d d- `T,> ` 45 I-,Z*1- at -re_
T!;w �.# I R � ��`Gt i �i r✓c i y►�- q • �j�� C0't�J�a' f rC ev-01,
-T 7t1���-rOTee- 1-rd , #G /14� STrd
Reviewer/Inspector Name �r Phone:
Reviewer/Inspector Signature: Date:
f L/La/V4 4Vnurgwcu

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EF<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CTNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EI'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2<o
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[-woo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[_�,
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,"��10
L5"iVo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0-50-
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�_,,,,��
L'_T1Vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UNo
❑ 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
Bil o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�,,�
E o
❑ 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
E o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
0� "
/+ r _V i Yt[1 eU0F %1 `i.5 i_ee�Y ✓�'/L� r1J d6 Yd !.///i (p.� / `LU�4c/r
7.4-1 7twe.) h e- heu A - ow L
as ��ben cp�� � a,� �� wD� 4: /sr- 7—a,
Page 3 of 3 12128104

ivision of Water Quality
Facility Number--� O Division of Soil and Water Conservation S ,
-- - - Q Other Ageney .
Type of Visit &Compliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ArrivaI rime: I It'l-3- Q Departure'rime: Q L County: Pr Region:
Farm Name: 7:��rca AID1/e_ Owner Email:
Owner Name: __ �iiJ i �� Iai'd, Phone:
Mailing Address:
Physical Address
Facility Contact: _:y �C ���' L Title: Phone No:
Onsite Representative: S w Integrator. -
Certified Operator: _f _Oz _ _ Operator Certification Number: �� 7
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Back-up Certification Number:
Latitude: E—] 0 0 ' =] « Longitude: = ° 0 6
Design Current Design
n Vet Poultry Capacity Population Cattle,, - Capacit
❑ Layer 4.
❑ Non -Layer
Dry .,Poultry
U Boars i
Other
-: ❑ Other I
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ElOther
a- Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifer
i
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
I
F
Number of Strutitures:
b. Did the discharge reach waters of the State'? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of -the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2- Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
❑NE
El NA
[1 NE
❑Yes
❑No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®I No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: / c�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[N 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
;D No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IS 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 C4 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?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) 0 e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® 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
N No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ®�_ Phone: /v- -33ao
Reviewer/Inspector Signature: Date:�r-

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 91 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ W`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? ❑ Yes VO No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? . ❑ Yes 4 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gg No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review P Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit: Arrival Time: Z 15 Departure Time: County: Region:
Farm Name: �e- T U� 1iC -_ Owner Email
.
Owner Name: �.11 �_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Title:
Phone No:
Integrator:_____
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= c = { = Longitude: = o = t = 4f
Swine
Wean to Finish
Wean to Feeder
,Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
El 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No QdNA
❑ NE
❑ Yes
❑ No PNA
❑ NE
❑ No NA
❑ NE
❑ Yes
❑ Yes
P No ❑ NA
❑ NE
El Yes
❑No�NA
El NE
12128104 Continued

Division of Water Quality
[Titity Number O Division of Soil and Water Conservation
O Other Agency <Y
Type of Visit 0 Compliance Inspection 0 Operation Review A Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other El Denied Access
Date of Visit: � Arrival Time: tiS Departure Time: C�� County: n Region:
Farm Name: Te_r l Q 1V Cn JQ Owner Email:
Owner Name: uV 1 IV,� Phone: a
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede,
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone No: 2
Integrator: I ` ► `L
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 d Longitude: [�°[�&= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population:,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
"' I
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No [,9 NA
❑ NE
❑ Yes
❑ No ['NA
❑ NE
❑ No ,@ NA
❑ NE
❑ Yes
❑ Yes
KI No ❑ NA
❑ NE
❑ Yes
❑ No V NA
❑ NE
12128104 Continued

Facility Number —Z Date of InspectionJ�
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
-No El NA El NE
a. If yes, is waste level into the structural freeboard?
El Yes
o ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Struct e
5 Structure 6
Identifier: _ Z—
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A3 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 XNE
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 9&NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA XNE
(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 Cl NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA [ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA 91NE
❑ Excessive Ponding [I Hydraulic Overload Cl Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
//''
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement'!
❑ Yes
❑ No
❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
PINE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
P NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
4PNE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: a
!L/Zo/f/10 [.Vis j9Vu

Facili Number -- Date of Inspection U
f! 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/l` o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z-
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
,0 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA
kNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA
(] NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA
NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA]
NE
maintenance or improvement?
Waste A2plication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA
NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA
�aNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
)0 NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ No
❑ NA
)ANE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
X[NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
P NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
44NE
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):
��nn b00_A d
cUVcL
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date: h
(L/L0/U4 Uunirrruea

Facility Number: Date of Inspection
~ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA (KNE
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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
[:]No
❑ NA
VINE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain
Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ No
❑ NA
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
�;NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
PINE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
711E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑ No
El NA
F 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
❑ No
❑ NA
PTE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
`PNE
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
P NE
12128104

p
L
F45ifi?y Number: Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
❑ No
❑ NA
T NE
❑ Yes
❑ No
❑ NA
® NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
V1 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
❑ No
❑ NA
NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
P NE
25.
r
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
®,NE
26 r
Did the facility fail to'have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
P-NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
1�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 ❑ No ❑ NA P 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 GjiNE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA $U NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA fD NE
12128104

0
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
er Reason for Visit Routine Q Complaint Q Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I o?"Z D I Departure Time: County:
Farm Name: z�f -/`Q PdGt // Owner Email:
� �Q Owner Name: rG[__ Phone:
Mailing Address:
Physical Address:
Facility Contact: GCJ' ,Zi e J>"4/� Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 u Longitude: o
Region: % ./1 D-
r1Design Current ;Design Current
Swine Opacity Population Wet Pou try. Capes Population
❑ Wean to Finish ❑ La er
_ Design
Cattle Capacity
Current
Populafion
❑Dai
Cow
ElWean to Feeder
❑ Non-Layet
❑
Dairy Calf
Feeder to Finish
3 (
❑
Dairy Heifer
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
' ❑ Gilts
❑ Boars
FIE71her
_Dry Poultry-
El La ers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Turke Poultsm
❑Other
❑
Dry Cow
❑
❑
Non -Dairy
Beef Stacker
El
Beef Feeder
❑
Beef Brood CovA
- -
3'
Nuber of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ElOther
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. 1s there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N. No
❑ NA
❑ Nl:
[:]Yes
EgNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
A No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / !
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JS 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
10 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
J4 No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5d No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/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 Drill ❑ Application Outside
of Area
12. Crop type(s) 1.f " xli jJ. _ L14Z a
13. Soil type(s) j( 24
sddiffer �from
14. Do the receiving crops those designated in the CAWMP?
❑ Yes
[K No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
20 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
O No
❑ NA ❑ NE
Reviewer/Inspector Name < �'f1z~ d---`� R: Phone �/�"V33 J3
Reviewer/Inspector Signature: Date: /
12128104 Continued

Facility Number: — Date of Inspection rL - 7
Required Records & Documents
I9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. U'Yes ❑ No ❑ NA ❑ NE
A 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
[0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O 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
0 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
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
10 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IR No
❑ NA
❑ NE
Additional Comments and/or.Drawings _ vx
Page 3 of 3 12128104

N
Type of Visit 6'Co—mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &, outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 'DU I County: ram"' Region:
Farm Name: j'1''GL _ i/GZ _ I Owner Email:
Owner Name: 13 �d!'bf / Phone: /
Mailing Address: ����aky
.� _ a l� f�crf "17/K
Physical Address:
Facility Contact: w i it f r IE ✓d_ Title:
Onsite Representative: _ S_&-z*q_e
Certified Operator: 4.K_k+.�
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number: 7
Back-up Certification Number:
Location of Farm: Latitude: F--] o ❑ ' 0 u Longitude: = ° 0 ' = "
Design
Swine Capacity
Current Design Current
Population Wet Poultry Capacity Population
❑ La er
n-La er
�� '
Dry,;Po�1.trY,w�.
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Dairy Cow
❑ Wean to Feeder
❑ Dairy Calf
ecder to Finishb&7'Z_11
Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Farrow to Wean'
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts
❑ Boars
❑ Beef Brood Cowl
Qther
-
Nutnbero#'Structures:
❑ Other ❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[K No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
rM No
ElNA
ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ANo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
[�rNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4No
❑ NA
El NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ yes
,XLNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
,! 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes CRNo ❑ NA ❑ NE
Structure 1 Structure 2 'Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: q
Designed Freeboard (in): /
Observed Freeboard (in): �?
v
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J4 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [,Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes g) 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 [SNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [4 No ❑ NA ❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 234nmJzd,b 6, L2,a 7z &
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
.Comments (refer to question #) Eaplatn'any YES answers and/or any rec6inm ndatio'ns or any other commentgh
Use drawings of facility to better explain situations. (use additional pagessas necessary): '
i c_s r � .
Reviewer/Inspector Name i Phone: 8_
Reviewer/Inspector Signature: Date: //'off fl)�
t'age 1 of .3 1212 /v4 Lonunuea

Facility Number: 91— Date of Inspection 1 04:>
i Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [X No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Eallo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ 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
D4 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
9) 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
Dd No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Mspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments-an&/o .'I)rawings:.
H
Page 3 of 3 12128104

Type of Visit (-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:: Departure Time: County: Region:
Farm Name: �1` C.L �/ Gt _ Owner Email:
Owner Name: f Phone: - % 0
Mailing Address: -3,2 &R a.S_r ^- da e- Rd C 2?cb=
Pltvsical Address:
Facility Contact: _] 1 �; 1 ; r 7--- r"dt _Title: Title: Phone No:
Onsite Representative: _�ix�-rle Integrator: 12&,w. 1 y �ti Yrr�r
Certified Operator: .!5a u e Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o ❑ ` ❑ `, Longitude: = o = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et - -
❑ Wean to Finish
❑ Wean to Feeder
U31eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non-L.
Pullets
Turkey Poults
Other
Disehary,es & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
F-
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
N
■
Number of Structures: © 1
d. Does discharge bypass the waste management system? (If ves, notify DWQ)
2. Is there evidence of a past discharge from any pan 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 KNo ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
❑ Yes
tZ No
❑ NA
❑ NE
❑ Yes
(K No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
12128104 Continued

Facility Number: 09--/dZj Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C&No ❑ NA ❑ NE
a. I f yes, is waste level into the structural freeboard? ❑ Yes UNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ �`� 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed []Yes
[9No
❑ 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? N Yes
❑ No
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
;9 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
CO No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
D4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
NJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/! [:]Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Dq 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
C4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
04 No
❑ NA
❑ NE
moo?,
Reviewer/inspector Name Phone: D— $
Reviewer/Inspector Signature: Date: Zo- --a
12128104 conunuea

Facility Number: —43 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 XNo ❑ 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
,4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
® Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W'94 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
',Q 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
CK No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PQ No
❑ NA
❑ NE
A ddihonall Coinments3and/or -Drawings• e _ 's =<rfr a' spa ✓g : '.
®r•-
7
(12?j W have 4Pt ,c do H e_ brfvr�rar-
12128104

IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit • Routine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3Z Date of Visit: o Tune: ' O
O Not Openationall O Below Threshold
U15ermitted ©tiertified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: -- -- ^-a _ Nolea County: / Q-----
� Owner Name.• �,, &_�,_, ,� car _•, Phone No: gio-6,.�- 12„x2
Mailing Address: 3 Z & fR�s, � r/ Ckockt m NC
Facility Contact: _____11V1 �:'r Qcar. tie; _ Phone No: y/c7� G off' G sr� y
Onsite Representative: ------ -- ---- - GZZZL lei, drad integrator:. Al fZ AAg
Certified Operator. T �•��, G !�t&ra� Operator Certification Number:
Location of Farm:
I&
01,Surine ❑ Poultry ❑ Cattle ❑ horse Latitude • u Longitude '
Discharges & Stream hnoa
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ITo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B'No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 0-No
c- If discharge is observed, what is the estimated flow in gal/rnin? -r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes BITO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9-o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E3 iNb
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes BNO
Structure 1
Identifier: _ l
Freeboard (inches): .3 4 h
12112103
Structure 2 Structure 3
-2 - - - --
3y
Structure 4 Structure 5 Structure 6
Candnued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes [94T0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 0-go
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? ElYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [9•No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes RVo
elevation markings?
Waste Aimlication
10. Are there any buffers that need maintenance!unprovement? ❑ Yes M No
11. Is there evidence of over application? If yes, check the appropriate boa below.
[:]Yes [3'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
r- �76 �-sqo / 1 -
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [94W-
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes EI'1Go
16. Is then a lack of adequate waste application equipment? ❑ Yes UND
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B-P'o
19. Is then any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [lido
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes gj#o
Air Quality representative immediately.
Ccmnats (refer tv a #' Edam aa�'°YES aad/o ia�rp�#hrc oomnnts. -
y;---
x ® _fan -..
€[3se dratwmgss ci'y to better � sa�rq�..{� � P� � r9r� ; j��ld Final Notes � � �"
7 Lr5&'P7 i {ios a �or/e aP.7` w,'fli C�pS�'7 ��a1� 4ee A 76 ie
re'e'a;reef,
ewer/inspector Nameewer/Inspector
E
Signature: Date: o
.&"IZ"U.7 LOBunum

Facility Number: — 3Z Date of Inspection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes (-No
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wehec fs, deli fi, mjK, etc.) ❑Yes G46
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 91;ro
❑ n- ❑ ❑ w�m *Mb*eis ❑SG4 sang
8--Pt,-->,.3,/3 &4Y ) 3.9,3.7 v-Q-> >.s-.�.
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes O-KO
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑?C
27. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes
04NO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5; No
INMES Permitted Faci'iities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
9—Ye
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[}'Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
MIZO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
allo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
P-WO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
E?Tb
❑ &MICing ym ❑ � ❑ &asp i i , Pcsiw
❑ u
I2/IV03

► Site Requires Immediate Attention: Aly
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Sr , I995
Time: q ; t-U
Farm Name/Owner: Te.rr a Ova aa (7EZ IA— A—t- _ 3e=--/
Mailing Address: EA- cLJ / 9
County: /3/aw,-
Integrator: Phone: A4 2� 9 n -- - -
On Site Represen A Phone: "I - Z/jl
Physical Address/Location.
Type of Operation- Swine Poultry Cattle
Design Capacity: �5- � _! Number of Animals on Site: 3A
DEM'Certification•Number: ACE DEM Certification Number: AC
Latitude: 0 Longitude: -
Circle Yes or No
Does the Animal Waste Lagoon hpye sufficient freeboard of I Foot + 25 year 24 hour §1orm everq
(approximately I Foot + 7 inches) or No Actual Freeboard Ft Inches�
Was any seepage observed from the I n(s)? Yes orTo Was any erosion observed? Yes or No
Is adequate land available for ray? Y or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling!) or No
100 Feet from Wells? Y or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(W
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N&o
Is animal waste discharged into water ofjhe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management reco s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

210
-6 CPL
SMITHS . I—%.
POND
70
At
BLADEN
ONES LAKES
-A KE C�� iLL ;i- e.lh.l QF i
u
v t AA Y TREE242 LAKE BIG
1�12 F Whit. Lot. BAY
at
A,
33 Un w LAKE
33 row. 968
WHI
to&
L151-3
21&
EUZABETMHTO
t I
pop. 3,331
``'BROWNS
I
z
L;
STATE
FOREST
SINGLETARY
LAKE
k.
N
T 7
1531 NA
53
LM
tn3 171,
16 3 :L 1716 41 t
Skmien
to
1.6
17 1.
'1713
Jl-
1712
1710
q
1.3
0.6
1710
LM
LM
1eDins
171
46 3al
lkko
3 E
p
1763
c�
% .
to I ol
fz
4
1
5
17
EP*m M
715,)
17
k., 1747 17
17AS
COUNCIL
17
b � 4 7
17U
'L
711 POM
1713
site".
TUSSOCK
BAY