090138_INSPECTIONS_20171231

0 Division of Soil and Water Conservation ❑ Other Agency
12 Division of Water Quality
10 Routine O ComDlaint O Follow-un o€ D'l'i'O insnection O Follow-uu of DSWC review O Other I
Facilit N b v' / Rr
Date of Inspection
y um er
I Time of Inspection � 24 hr. (hh:mm)
❑ Registered ■ Certified E Applied for Permit ermitted ❑ Not O erational Date Last Operated:
Farm Name: � �2� rA.......... � ..: � . r�,�, County •......................... -................................... ......................
Owner Name: .............. ........................................ Phone No:.J ..f %O �Z - cs %%%....................,
...
Facility Contact: ........, ........ffe. Title: .--....... ........ Phone No: ................
Mailing Address:
......... ..D........................���.............. mac: �5'...3�'
Onsite Representative:.,....... .... Integrator:-..............................................................................
Certified Operator:.........•.�-
--��.++�,-----......� ---------------------- Operator
�1_ti=------ - - !�.. .................. O rator Certification Number:.-._22a 7(..._._....
Location of Farm:
�.................................:.................................................................................................._....................-----•----.....--.....-................... ........ ..........................
Latitude 6 « Longitude C • 6 "
,I?estgii.. Ctirrent'r
Design Current _"=DesigEi . Current
.'CapacttywPopulatton.
Somme • " =Capaeity. Pbpntatron
�.r,
Porittry ;Capacity,"Population ¢Cattle„"";w
❑ Wean to Feeder
❑ Layer ❑ Dairy
IR Feeder to Finish
❑ Non -Layer �'❑ Non-Dairy�s
❑ Farrow to Wean
t_
" Farrow to Feeder d OD
❑ Other xb x
❑ Farrow to Finish
s'Total Destgn Capacity �;
❑ Gilts
�' q
:. ❑ Boars
t Total SSLW
Number of )loons I Holding Ponds
❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Feld Area
.....
x z x .. .......
° ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated ar. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notifv DWQ)
c. 1f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes Q No
❑ Yes 91 No
❑ Yes 91 No
❑ Yes ,R No
❑ Yes NLNo
❑ Yes 1 kNo
❑ Yes KNe
❑ Yes KNo
❑ Yes No
❑ Yes No
Continued on back

a
Facility Number: 6r9` gZ7
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes J.K No
Structures il,a2oons.Holdin2 Ponds. Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes XNo
Structure l Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
/.........1...............::++.1...............................�`2..... .............................__...........................
Freeboard(ft): ......... ,.?~C..Z.S 1./........................... 1.L.. ........................................... I...................
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
'Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ! ... .,�.. f..., .1�r.�1. .P,+ l......................
............
.................... ........
......... I ...
..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities On
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violitioh've defidencies: were: ho- ted-during this:visit.- You:wiA eecei-Ve.no-ftiriker_ : ,
:.�rorrespotidepceatiout�this:visit:-:•:•....- •.•-.�: � :�: .•.��-.•:-.�:�:: � .• •. •..-.•: .•
❑ Yes K No
❑ Yes XNo
❑ Yes No
❑ Yes fifNo
❑ Yes 19 No
❑ Yes ANo
❑ Yes §(No
❑ Yes h<No
❑ Yes PSNo
❑ Yes Wo
❑ Yes XNo
❑ Yes MNo
❑ Yes J9 No
❑ Yes )�No
❑ Yes A No
7I25197
..
Reviewer/i
nspector N•arne_
Reviewerllnspector Signature: Xd r- �7 - a�Q'� Late: ��

Type of Visit: ®Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 8 Routine O Complaint O Follow-up Q Referral Q Emergency 0 Other O Denied Access
Date of Visit: �]� 7 Arrival Time: p ; (� Departure Time: �' County: AJ"_
I — 1
Farm Name: _ P^ ! y i�` S 1 Owner Email:
Owner Name: _pl�S C§Q Pd4frLts Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
u
Certified Operator:'��p(� ypy�
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator: Q.Q`
Certification Number: qV��
Certification Number:
Longitude:
Design Lament
Design •Current
M128.1urrent
Swine�Galacity,; Pap.
Wet Poultry
Capacity -. Pop:..
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er
DairyCalf
Dai Heifer
vi Farrow to Wean
Design Cuurrent
Cow
Farrow to Feeder
D . I;o_nl
Ga ac' Po
Non-Dairy
Farrow to Finish
Gilts
La ers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turke Poults
OtherIII
jOther
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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.) F
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes LU No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes [�No ❑ NA ❑ NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
1 1. 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,Ln, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge'into Bare Soil
❑ Outside of Acceptable Crop Window , ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA�
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1� No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: .0
24. Did Vthe 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 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 No ❑ NA ❑ NE
❑ Yes 1P
No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes f No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 A
No ❑ NA ❑ NE
Cnmzi�ents¢(refe to gnest,on' Exp��n any YES anpswersland/oir byraddittonal recoruirnendattansiorwany,otherroomments. 4,
Iri-.I IE'JL� OkC I{8 . �u � '.'M' � ,� -"d �.'�. �'�: � +�„yc-:.j�': 'rY.. 1 �n � �... tlli= r . .x, r - I
Use drawrn :of 5crlitytto?better expla�u srtnations (use additional pakes,as necessary)'.
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3�
Date:
21412015

I4-
Date of Visit:
0
Arrival Time: ,00
Departure Time: / County: LAAu
Farm Name:
—A
- .
Owner Email:
Owner Name:
re�
gQ s
Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: JaftteS L&-,y . Title: Phone:
Onsite Representative: U Integrator:
Certified Operator: �2.rP��y► ►%,go" Certification Number: nj g�7JD
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
J
Design C•nrrent
Swine -
Capacity Pop.
Wet Poultrypacity
Pop.
C . L} ,:
Capacity Pop.
&
Dai Cow
Wean to Finish La er
Wean to Feeder
Non -La er
Dai Galf
Feeder to Finish
�..,:_
Dairy Heifer
Farrow to Wean
Z
Design
;D `:P,oul " ��= .Ca aci
Current.
Po .
Cow
Non -Dairy
YJ
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
`
Turkeys
Other
Turkey Poults
Other
Other
Discharees 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 01 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes jig No
ILA NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3
21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �9 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): 7 ZJr'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? 7�
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [DNA ❑ NE
Aj
❑ 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 AcceptableCropWindow ❑%E'vid�ence of ind• ft ❑]Application Outside of Approved Ar
12. Crop Type(s): ec�QQS7'��i
13. Soil Type—fs}: 'a io
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes TP No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes
© No
7®�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. C] Yes q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 1p No ❑ NA ❑ NE
❑ Yes r�f No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: C4 - 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes §3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Co No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes � No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
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
TO
❑ 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
o
❑ NA
❑ NE
Comments (refer to question # ): Explain any -YES answers and/or any additional reco emendations. or any other comments.
Use drawings of facility to better eizplain sit ahons'(use additional pages as necessary,).
- = }:°
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` f 0—V 35 'm
Date: ! 3
21412011

(Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [, Arrival Time: Departure Time: County: �- Region:
t
Farm Name: '� S Owner Email:
Owner Name:*d" Phone:
Mailing Address:
Physical Address:
Facility Contact:
Q8 L Title:
Onsite Representative: N
Certified Operator: 'Tw" L% Ry&r '.SOS
Phone:
Integrator: Q c
Certification Number: / g57�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Curren#
Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Finish La er
rgFeede]rto
DairyCow
Feeder
Non -La er
Da Calf
Da Heifer
Finish
)JIFarrow to Wean Design Current. ,,
D Cow
Farrow to Feeder D . Poul Ca aci P,o ,_
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars Pullets
Turke s
Beef Brood Cow
--..-...
Other Turkey Poults
Other I I I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes r o ❑ NA [] NE
❑ Yes [] No
❑ Yes [—]No
NA ❑ NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No K NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:_
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� 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
❑ YesAM
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 'W No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10.1bs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A.
12. Crop Type(s):
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes q9 No ❑ NA 0 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 r D No ❑ NA ❑ NE
[:]Yes P No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1p No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f] No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

1.
Facili Number: :zjzDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
Z) No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
0 NA ONE
the appropriate box(es) below.
Failure to complete annual sludge survey OFailure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
[ No
NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
[� No
NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
® No
NA ❑ NE
and report mortality rates that were higher than normal?
T�
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
_�g
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Dg No
0 NA 0 NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
No
0 NA 0 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 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
�o] No
NA NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
No
NA NE
er to dthonai recommendations or4tiestion mm
Comments(ref i y answers and/or
pages;r editionas.ncessUse drawinofcilit3 Esin ituatins uents;'
o bettEYP
.e ..-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qlo L33-334)
Date:
21412014

'type of visit: Compliance inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 Arrival Time: � Q D Departure Time: County: BLADEW Region:
Farm Name: P-1` 5 B Owner Email:
Owner Name:r�es-�-aae ��.Yrn S C' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �Qr 1�.+'Y1aG�
Certified Operator: O�XY1 y FO� 1 e_�SOn
Phone:
Integrator:
Certification Number: 5-7-5 _0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
can to Finish
Design Current
Capacity Pop.
}Design Current Design Current
op.
Wet`Poultry Capacity Pop. Cattle Capacity PZA
La er Dai Cow
Wean to Feeder
Non -La er Dai Calf
Feeder to Finish**
Farrow to Wean
l Dai Heifer
Dry Cow
14111
Farrow to Feeder
D , pP,ovCi P,o , Non -Dairy
Farrow to Finish
La ers Beef Stocker
Gilts
Nan -La ers Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
® NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: q -OK I jDate of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
if
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pg 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 W 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? [D Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J ] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (51 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 ❑ Evid ce�of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &'TA�1 &" "0 37 TT.I�e .f -SIhn . G_r4H Oates%�
13. Soil Type(s): to
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes Q§ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j§ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® 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 No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:)Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [v No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis D Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 [ 9 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: L
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 reiated to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:)Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments r � '-
Us.e.drawings of facility to better explain.situations (ase.additional pages as necessarv). � .. .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1-� 12
21412011

Type of Visit: ® Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:® Departure Time: [� County: Region:
Farm Name: � P-3 Owner Email:
Owner Name:i(�$ �C�rfMSf1C_.
Mailing Address:
Physical Address:
Phone:
- 71.
Facility Contact: �� fY1E? S Lj:X.WV _ Title. Phone:
Onsite Representative: S Lo_r�n Integrator: f1
+�-� }
Certified Operator: J �,..5Of-) Certification Number: C��ZJ �'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swinapacity
Design Current Design Current
lCapPop.r7FF
inish
La er
Dai Cow
eeder
Non -La er
Design Current
Dr. Paul Ca aci Po
Da' Calf
inish
Wean
Dai Heifer
D Cow
Feeder
Non-DairyFinish
La ers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Aj
Other I
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 a] No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes [:]No
❑ Yes ® No
❑ Yes ® No
NA ❑ NE
�NA ❑NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

t IFaciffty Number: Date of Inspection: �2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -----
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
E5 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
[—]'NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes -[9 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): LI ,'e_ SM rani {
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:)Yes
® No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

` Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes q�jNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 K No ❑ NA D NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes 53 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes © No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE
r
mneats (refer to question.#); Egplam anyYES $nswers andlorany adadditionalnal recommendatzons or.any othereoumen#s:
:drwin s of facility, t6"tatter explain situations use additionaes as',necesse'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /0 `3
I lt4�
Date: ( y
21412014

Type of Visit: a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I
4 j Arrival Time: Departure Time: j,�,� County: B� _�/�/ Region: I"f�L1
Farm Name:_ 14__A_5 Fj Owner Email:
Owner Name: Trts S pNc-% Phone:
Mailing Address:
Physical Address:
Facility Contact: ' Title: Phone:
Onsite Representative: �a+'rQs C.�{.�,,jj3 Integrator: S
Certified Operator: �� eWI 1�pr Certification Number: 9IF) -5,zy
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Gnrrent Design Current
Swine
Capacity Pap.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
.,
Finish
La er DairyCow
Feeder
Non -La er Dai Calf
`' DairyHeifer
o Finish
o Wean
FFarrow
Design Current D Cow
o Feeder
D . P,oul _' .;Ca aci Po . Non -Dairy
o Finish
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Boars
-
Other
Turke Poults
Ether
Other
D_ischarzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No []NA []NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes []No RNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

t
Fatfflly Number: jDate of Inspection:
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
Identifier: r/7L
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
1?0No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
j� No
❑ NA
❑ NE
maintenance or improvement?
T
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 Wind Drift ❑ Application Outside of Approved Area
Dof
12. Crop Type(s): Coa SM L
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
U No
❑ NA
❑ NE
the appropriate box.
❑ W UP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes FP 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 W No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ED No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Fa&fty Member: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes fT No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes t� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes W No ❑ NA ❑ NE
[:]Yes Rg No ❑ NA ❑ NE
❑ Yes [)—d No ❑ NA ❑ NE
❑ Yes EP No
❑ Yes Qg No
[:]Yes ®. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
iComments (refer to question #): Explain any YES answers and/or any additional recommendations or;any other comments: "
Usedraiwiingsof facility to better explain situations (use additional pages as necessary), �, _, , , _ �� „ Zi
ye,,ds r2V;eAJ
Jl ' r I o n
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3
Date:
21412011

J
Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: p. Departure Time: County:
Farm Name: P 14 A; 9 Owner Email:
Owner Name: resFarms ---Cr)G Phone:
Ili
Mailing Address:
Region: FPO
Physical Address:
Facility Contact: Title. Phone No:
Onsite Representative: a _S 1..��J'1'lb Integrator: r�e
Certified Operator: (� SOIL Operator Certification Number: _ r f3S2
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=] o 0 , 0 " Longitude: = o ET = "
Design Current DesigQ Current
Swine Capacity Population Wet Poultry Capacity Population
Design Cnrrent
Gat#le Capacity Populatiou
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I ❑ Non -La er I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Feeder to Finish
Farrow to Wean Dry Poultry
Farrow to Feeder
❑ Layers ❑ Farrow to Finish La
❑ Gilts ❑ Non -Layers
❑ Boars ❑ Pullets
❑ Turkeys
urke Poults
Other EE10ther
El Other
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Leo ❑ NA ❑ NE
❑ Yes
❑ No
qNA
❑ NE
❑ Yes
❑ No
FNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
[�)No
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of inspection �4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IP No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes • ❑ No
�bNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: —ram
Spillway?.
Designed Freeboard (in): LA
Observed Freeboard (in): ll 3 k 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E�l o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[--]Yes Ij 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? l
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 101bs ❑'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window) ❑ Evidence of Wind Drift El Application Outside of Area
��[rvt
12. Crop type(s) w t 4d a C S srr ,
13. Soil type(s) f and
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
OyNo ❑ NA ❑ NE
No ❑ NA ❑ NE
[� No ❑ NA ❑ NE
[�nI No ❑ NA ❑ NE
PNo El NA ❑NE
Comments (re..fer to.question #) Eaplain. -any YES`answers and/or any recommendations or:any other comments,
r
Use drawings;of facility to betterrexplain situations. (use additional pages as necessary)
IF
Reviewer/Inspector Name }h Phone: 33 3
Reviewer/Inspector Signature: Date: In
Page 2 of 3 12128104 Connnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Gheck[ists El Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 JN No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes ❑ No (P 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
F41 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
IR No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than nonnai?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1W 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
J�j 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
P No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit * Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: b s+� M County:BLAA
1
Farm Name: S Owner Email:
Owner Name: -F`hC.t Phone:
Mailing Address:
Region: RRD_
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representatives La" Integrator: ?�14wgL
Certified Operator: hr1 b� n 5e1 Operator Certification Number: r ��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =1 e = ` =" Longitude: = o = I = "
Design OuFEnt
Design Current
Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Non -Layer
❑ DairyCow
❑ Da' Calf
❑ Da' Heifer
Dry Paaltry
❑ D Cow
❑ La ers
El Non -Dairy
❑ Non -Layers
❑ Beef Stocker
El Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Other
❑ TurkeyPoints
❑Other
Number of Structures:man
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
3
Farrow to Finish
❑ Gilts
❑ Boars
Other
Discharges &Stream Impacts
Is any discharge observed from any part of the operation? El Yes Q�No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
❑Yes
❑ No
[0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
TNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (]f yes, notify DWQ)
❑Yes
❑ No
O NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
gNo.
No
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

U4
Facility Number: Ll — 130 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Stntcture I Structure 2 Structure 3 Stnicture 4 Structure 5 tructure 6
Identifier: A- 1_4 77
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5D ef
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 01No ElNA ElNE
through a waste management or closure plan? ll
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes o [INA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenancelimprovement?
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 ❑ Evidencg of Wind Drift ❑ Application Outside of Area
12. Crop type(s) t_C7-��.._--
13. Soil typo(s) ! _ CL Li gad —
--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZU No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
t& No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
prNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
El NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
�9 No
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: `i _53-35
Reviewer/Inspector Signature: NaM Date:
IW8/04 Continued

�w ti
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes W No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DN No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
hm
p No
[3 NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a] 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
E 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
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
1.
Date of' isit. Arrival Time: %/=Q7q Departure "rime: County: L-ft Of v Region:' _
t1 �
Farm Name: Pry S _ _ Owner Email:
Owner Name: prey- l�!`MS _ Phone:
Mailing Address:
Physical Address:
Facility Contact: T Title:
Onsite Representative: 0 S LLVIL- _ -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [�J o = ' E�] " Longitude: = o ET
= "
Design Current T Design Current Design Current
Swine Capacity Population Wet Poult]. Capacity Population Cattle Capacity Population
❑ Wean to Finish �t ❑ La er ❑Dai Cow
❑ Wean to Feeder
I0 Non -Layer
ify Calf
❑ Feeder to Finish
fi ❑ Dairy Heifer
.'-^-_ El D Cow
DEytPouEtry'
;" ❑ Non -Dairy
❑ Layers
❑ Beef Stocker
Farrow to Wean
Farrow to Feeder
Q
❑ Farrow to Finish
❑ Non -Layers
` El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Beef Feeder
❑ Beef Brood Co
Numbeirof Structures:
❑ Gilts
Boars
Other
❑ Other
_,..
❑ Other
;aham
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PgNo ❑ NA ❑ NE
❑ Yes
❑ No
IPNA
❑ NE
❑ Yes
❑ No
�TNA
❑ NE
6NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes IpNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

G
Facility Number: — Date of Inspection 8 2?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes r No
❑ Yes ❑ No
El NA ❑NE
RNA ❑ NE
Structure 1 Structure 2 Structurej Structure 4 Structure 5 Structure 6
Identifier: low
Spillway?:
Designed Freeboard (in):
36 ''� �g
Observed Freeboard (in); 33_ _.
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
1P 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
IN No ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5§ 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
lSvo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
V] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
pu 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/'Acce Window Evidence of Wind Drift Application Outside of Area
Jpt-a'bleQC�rop
�❑
n r❑ ,
12. Crop type(s) Lo45i�-1 l w'WIJOL C5,V % [ iGa ), 61%4, t'R.tO
13. Soil type(s) L —Lad
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 19 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes VJNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3No ❑ NA ❑ NE
Carenr
wsgsUsmcefr to gnestioa #} Explain any Y,ES�,answers,andlor any recpmnaendatians or any�other comments.
factlio better expIain�situativns (use additia al pages as necessary).
i
Reviewer/Inspector Name Phone: t(� F Gil
Reviewer/Inspector Signature: Date: oZ l
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection I LYtirrG� J
Reuuired Records & Documents r r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA LINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V9 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EANo ❑ 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
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CS 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
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EANo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
59 No
❑ NA
❑ NE
�5 -
� ...� r
Add Ihonal,Commettts`andlor Drawtn sT
4g
AL
7
Page 3 of 3 12128104

2 Division of Water Quality
hmijity Number Q �� 0 Division of Soil and Water Conservation
- Q Other Agencyj.
Type of Visit `tt4ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit lth Routine 0 Complaint 0 Follow up 0 Referra'l 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 jo�iIp � I Arrival Time: Departure Time:�EU►y�`�I County:
Farm Name: 1 Lk Af & Owner Email:
Owner Name: es� YY1S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Da
Certified Operator: -AeA Operator Certification Nu er:
Bark -up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Region:
Latitude: = o = 4 = u Longitude: = 0 0 6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
O
El -Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Cow
Design , Current
Capacity Population
r.
❑ Dairy
❑
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
r�NA
❑ NE
❑ Yes
[I No
t)�NA
❑ NE
❑ Yes
❑ No
'�%qA
❑ NE
❑ Yes
o
I --]NA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Eta ciIity iVumber —
Date of ]Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes QtNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Stru ture I Strucllire 2 Structure 3 Structure 4 Structure 5 Itnucture 6
Identifier:
Spillway?:
Designed Freeboard (in):
nLZ
Observed Freeboard (in): `
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Nd 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 ['�,No El 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 F No ❑ NA ❑ NE
maintenance or improvement?
Waste AAAlication
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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) 06" r & C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I] No
❑ NA
❑ NE
No
❑ NA
❑ NE
Ep No
❑ NA
❑ NE
[§No
El NA
❑NE
[� No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name CA9_L(TIN� ►UTon.i `Phone: b
Reviewer/Inspector Signature:Cn&��Date: )
1117X1!!A V/'nnfin�lad

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Y$No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Fr
No ❑ NA ElNE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
❑ No,4�A
❑ NE
❑ Yes
too
❑ NA
❑ NE
❑ Yes
— No
❑ NA
❑ NE
❑Yes
1�No
❑NA
El NE
❑ Yes
❑ No
XNA
❑ NE
❑ Yes T No
❑ Yes ig No
❑ Yes No
❑ Yes f�No
❑ Yes t�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
E
12128104

t
Type of visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: '� � �0 County: ] WOW Region: D Arrival Time: s^"' Departure Time: ty eg� 12"
Farm Name: (T� Owner Email:
Owner Name: P��e Phone:
Mailing Address:
Physical Address:
Facility Contact: ( Title: Phone No:
Onsite Representative: 'T ' Integrator: Er"IL
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e 0 [ = " Longitude: = ° u
Design Current
Desigwwmn lkift t
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
.,
Cattle Capacity Population
Finish
❑ Layer
to Feeder
❑ Non -La er
r to Finish
to Wean oo r
Dry Poultry
�,
Eto
to Feeder
❑ Layers
a
ny
to Finish
❑Non -La ers
❑ Pullets
wl I
❑ Turke s
❑ Turkey Poults
❑Other
Number of Structures:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Da'
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
QUNo
❑ 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
P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�,�io
❑ NA
❑ NE
other than from a discharge?
It
Page I 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 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �}
Spillway?:
Designed Freeboard (in):
" � Observed Freeboard (in): 30ri t(
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
jj3 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
�jNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ip No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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) LaB
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo ❑ 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?
18, Is there a lack of properly operating waste application equipment?
❑ Yes 'M No
❑ Yes 53 No
❑ NA ❑ NE
❑NA El NE
Comments (refer to question #): Explain any YES;.aaswers andoo".r any. recommendations or any other com;m ne�� is
Use drawings of facility to better explain situations. (use'additional pages as necessary):
Reviewer/Inspector Name Fr_ __ i — -- - -- —h Phone: %/0` 1?_-JT _
Reviewer/Inspector Signature: Date: 7-.;zS-1g6
Page 2 of 12128104 Connnuea

L
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 No ❑ NA ❑ NE
the appropriate 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP)No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z 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
V9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
VO No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
0 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
O No
❑ NA
❑ NE
Additional Comments and/or Drawings':?=
Page 3 of 3 12128104

1.11
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 11115V,6.f Arrival Time: 3 : S Departure Time: County: Q J' safe u __ Region: FRI
Farm Name: P- l y p ' 8 Owner Email:
Owner Name: Pr e. s.+ST & #- rn C Phone:
f
Mailing Address: d i� a ,► �% 32 C 1 i as f a nr N C . •2Sf3•2P
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: R o% J u d r e..Pe n+ Integrator: P1 e_ s f a b s _
Certified Operator: J 4L1ht.r+.y� Rd i r t sal Operator Certification Number: 419S'75-a _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' ❑ Longitude: ❑ ° = 6 ❑ As
Design Cur en" Design
Current. x� ; Design Current
Swine
Capacity Papul non Wet Poultry Capacity
❑ La er
Cattle Ca aci Po elation
Popultton,,� P ty p
idM
h.
❑ Wean to Finish
on-Layet
�=
❑ Wean to Feeder
Feeder to Finish
r? U 7 Dry Poultry
i;
❑ Layers
ji� ❑ Non -Layers
s:fl
® Farrow to Wean
® Farrow to Feeder
❑ Farrow to Finish
Gilts
El Pullets
❑Turke s
}'V
❑ Boars
Other
`. Turk Poults
_ -
Number of Structures:
❑ Other
[] Other
❑
Da' Cow
❑
Dairy Calf
❑
Da' Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coy
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
❑ Yes
[Z No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LE No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�.B L`
Spillway?:
Designed Freeboard (in): rA)-"Q I 13 '9
Observed Freeboard (in):it
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® 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? 20 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 [l Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
7- j4 0}% 1— — _:�pa+-r ON
/.a 7 0,6" 6 4 A-7
Reviewer/Inspector Name L ffQ /�. r �:. {, ,,;;; Phone:
Reviewer/Inspector Signature: Date: f Q
12128104 Continued

Facility Number: — �3y Date of Inspection ?S oa
i6gired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 50 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? it Yes N 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
N 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
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
99 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
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional CommentsaandJoriDrawrngs � -� ,'` �` �,�IBM
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation i
LR_eason for Visit„0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility ?dumber Date of Visit: ? ' Tune: d ' S
1 Not 2eerational O Below Threshold
(D'fermitted EZICertified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name:P 8 County: ,1aa4e-
Owner
Name: p1 c� - , �r _ Phone No: q 1'O- S-f-7 - S 7 M
_k1afling Address:--f,x._.._.c.._ ..&. __ � ._ _ C l; � .283 8
Facility Contact- /Q,o+ Bar-& --- --- Title: Phone No:
Onsite Representative: Integrator. ---- FresAage
Certified Operator: _ fP ,�,� _ _ , Operator Certification Number:
Locaflon of Farm:
Ekll§wine 0 Poultry ❑ Cattle ❑ Horse Latitude �' �' �49 Longitade • d
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation? ❑ Yes 0416
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ['rNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ja<
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L?No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ET -go
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: id
Freeboard (inches):
12112103 Continued

Facility Number: 9 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [190
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes 124o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or emrvironmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes &Wo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Q<
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes B'i�o
elevation markings?
Waste Aoniication
10. Are there any buffers that need maintenance unprovement? ❑ Yes
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Imo
❑ Excessive PDDonding�� Q PAN /❑ Hydraulic Overload ❑ Frozen Ground El Copper and/or Zinc
12- Crop type Qeennrd. .sna:mod . SA,a.1l ppA,,A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q�o
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 0 No
16. Is there a lack of adequate waste application equipment? ❑ Yes 2<o
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 �io
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [j'No
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 Q'Na
Air Quality representative immediately.
's.K'--:-�i*'s'�^-»n, '..�t.,. .f�[» ....R,e
Tel ilQeStaQn:�1'� any �' /!1S � �' � OtBIIy�D_�etO�_
--"-
Use drawer cd�ty$to betttr {ase'att:ona! pap as z�+)- R�reld C Final Notes
�-�-.�� -. -_�. .a. -s` ..a�'� •.�.:.� w�.��'*�,3,.� sv -- �—.i.�'.:.—ism:_,. .e.i-. - - - -z�3-•---�...�.��
AL
�\L'cordS •ltv,'rn.r� a�., lI - 3U•dy
ReviewerAnspector Name
�. ter. L � �.-�'_..,.� � _.��..��_�=��'-��. -z•
Reviewer/Inspector Si$nattrre: Date: % —O
12112103 Conffnued

' Facility Number: 3 Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[-iffy
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑-No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑'Ro
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[]-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
[] Yes
�No
27. Did Reviewer/inspector fail to discuss reviewltnspection with on -site representative?
❑ Yes
Q'No
28. Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
29. Were any additional problems noted which cause noncompliance of the Certifie�! AWMP?
❑ Yes
erf10
IhTPDES Permitted Fac N ies
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[des
❑ 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
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑-Wo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
0 Ifii
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ C,rop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

er Quality +.o; s� € i z
..r..?_ .-.�, t.r
Type of Visit @) Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: 5-27-2Q04 Time:
Facility Number 9 138
5 Not operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ............... .........
Farm Name: X'-14. A►+&B ......................... County: l ladcq-....-..-.....................-•--.--....---•-. F
............................. ..... ........................................•----• ••-•.....--•
Owner Name:
Ptrestage-Y^ arms ------- ------------------
flailing Address: F.0..BOx.43&...............................................................................
Facility Contact: ........................................ -.---.--..-......-..----..--.--Title:.--..
Onsite Representative: „-
Certified Operator:,Jetrrmy.Pave....................... R-abxatsant.....-......-........
Location of Farm:
Phone No: (91.01-592: 7.71-------------
coattail..N.C.....-•..................................................... 2.32.8--••-••-••-•-
Phone No:
Integrator: QCestage.1 arm ........................
Operator Certification Number: 9852.50 ..........................
lwy 87 north from Elizabethtown, turn right on SR 1316, cross river turn left at X-roads onto SR 1318 (River Rd) go 4.5 miles A
o farm on left.
® Swine ❑ Poultry ❑ Cattle ❑ Horse
.'Design Curr
Swine : ' Ca city -.
Po . nL
Latitude 34 •F-4-9­140©
t" Design Curreni
)n Poultry Capacity Populatic
❑ Wean to Feeder
® Feeder to Finish
4500
❑ Farrow to Wean
® Farrow to Feeder
2500
❑ Farrow to Finish
❑ Gilts
❑ Boars
Nuinber of Lagoons 3
: , iXntrlir�o Pnnrtc / Cntiel Trflnc-
Discharges & Stream Impacts
Longitude F 78 •
Design, `, Current
a Cattle CanacitV ` - Povulatioli
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier:
Freehoard(inches): .................................................... ......................... -......... ........ ........................ •••..... —
l2/12103 (-anlinued

Facility Number: 9-138
pate of Inspection 5-27-2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ 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
❑ No
19.
Is there any evidence of wind drift during land application? (i,e. residue on neighboring vegetation, asphalt,
(:1 Yes
❑ No
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
❑ No
Air Quality representative immediately.
Comments (refer to question #) Explain ait� YES'answeis and/or any recammendat>tons or ariyother comments
y r s
Qse,drawEngs of factbty to bM6f'explain sithahons. (use aifdthonal pages as necessary) ❑ Field Copy ❑ Tma] Nnotes
y. {t�':..�' r _ s -,; r.?.-x .kni....'. .�. P _t'�.��'y;.,iIh o" `." r„ a fH ,. �. "i " ., ..'S`��3...a�. ?. r�:'44f,. � ,-` "r'�. i,j, 1i=:�5&.�k�.�•. «k'y���.*.q�::
WQ staff visted farm as a result of on aerial flight that showed an irrigation gun that was malfunctioning and cutting a ditch through the +
pray field. When staff arrived the spray gun was not in operation but appeared to be in good working order. No problems relating to
the irrigation event were noted.
E
erllnspector Name Mark Bi-aniley Larry Baxleyerllnspector Signature: Date:

,y
State of North Carolina
Department of Environment,
Health and Natural Resources A00W%
•
Fayetteville Regional Office AOM%
James B. Hunt, Jr., Governor p E H N
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
July 19, 1995
Mr. Glenn Clifton
Prestige Farms, Inc.
P. O. Box 438
Clinton, NC 28328
SUBJECT: Compliance Inspection
Farm P-14A
Bladen County
Dear Clifton:
On July 13, 1995, an inspection of your animal operation was performed by
the Fayetteville Regional Office (FRO)_ Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the.opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
# , jc?�
D. T. Jones
Chemist
Enclosure
CC: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville. North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation Type:
Horses, cattle, swine, poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL
WASTE MANAGEMENT PLAN?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
mom
INN
11mi

SECTION III
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue.Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately 3 €t plus)
B. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION Ili
Comments
*Section III - items #4 and #6
a. This facility has cover crop
b. Does not have Cert Plan until 1997
C. Following BMP
No interview
Type
Lagoon size
mom
mom

Pe ei i -c ' ? / � 4-
G DIVISION OF ENVIRONMENTAL MANAGEMENT
5,Narember
_ � �y �� , ��
Gt..wxai.s / to c. Z$3Z-0
SUBJECT: Compliance Inspectionq+t.�.-1';A
County 411V)1 i5w
Dear
On 7, /3, 16arn inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
Enclosure
cc: Facility Compliance Group

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH % NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGElEENT
Fayetteville Regional Office
4
Animal Operation Compliance Inspection Form
TTSPECTION
N]ATE
KWS (Lo 0 AW a
/� �
SR 13 1 $ r SR 132v
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation Type:
Horses, cattle, swi , poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
Poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation REGISTRATION?,
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL
WASTE MANAGEMENT PLAN?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

•. SECTION III
Y N COMMF,NTS
r Field Site Management
I.
Is animal waste stockpiled or lagoon
construction within 100 ft. of a IISGS
Map Slue Line Stream?
2.
Is animal waste land applied or spray
irrigated within 25 ft. of a IISGS Map
Blue Line Stream?
3.
Does this facility have adequate acreage
on which to apply the waste?
4.
Does the land.application -site have a
✓ �(
cover crop in accordance'with the
CERTIFICATION PLAN?
5.
Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6.
Does the animal waste management at this
I/
farm adhere to Best Management Practices
-
(BMP) of the approved CERTIFICATION?
7.
Does animal waste lagoon have sufficient
freeboard? How much? (Approximately V77 /
8.
Is the general condition of. this CAFO facility,
including management and operation,
satisfactory?
= SECTION IV
Comments
)E Stet -V- ,'TES 'f jo�'Vd'4
14 4 s G41/��2 6AV14
/j. fed �S ,raf h�✓� T /�, C C,rT �%w Gfv/• / 1997
r /O
I A36Q,v 5.'AE