090139_INSPECTIONS_20171231

P
Type of Visit: S Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: m Routine O Complaint O Follow-up 0 Referral O Emergency O Other
p O Denied Access
Date of Visit: Arrival Time: Departure Time: ; 4 County: !
Yj�p� �` Region:
am'
Farm Name: _ P' © Owner Email: *�'�`�
Owner Name: Ke6 bM-;-F& , _S Phone:
Mailing Address:
Physical Address:
Facility Contact: Ta4,v,6 La" Title: Phone:
Onsite Representative: U Integrator:5
t
Certified Operator: je mot` Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
nt -
esign Cutop
Desigu
Current
Design CurrenWEIpaeity
VIJet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Paul
Ca aci
I?o
Non-Dai
Farrow to Finish
Layers
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
l7ther,
ITurkey
Pouets
Other
I 10ther
Discharees.and Stream _Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑Yes No ❑NA ❑NE
a. Was the conveyance man-made?
❑ Yes
❑ No
PgNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
/ ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection: 72 r7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [gNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No k�J NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wio Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): CJ GX6 Lcl_�C$ QS s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Un 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 Pack adequate acreage for land application?
El 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? Ifyes, 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 T 21412015 Continued

,' Facil' Number: _7 jDate of Inspection:
,24. Did the faci Iity 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:
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
❑ Yes No
❑ Yes No
❑ Yes] No
❑ Yes �] No
❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes ;No ❑ NA ❑ NE
Uornme�nts (refer to q ttoif#) Erplain any YES answers and/or gny addrt�an L ornmendatioas or any other4 znmenLs.
Use drawmps o '# facility, to betterexplaws�tuattnns (ase additional paesssnecessary}
,i
Reviewer/Inspector Name: Phone: , t &-LI3 r33CC2
Reviewer/Inspector Signature: ZZLLA�LADate: Z! 7
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review O 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: 3h� County: dJM"!'r'N Region:
Farm Name: I O Owner Email:
Owner Name: S 1K5 Phone:
Mailing Address:
Physical Address: _ r
Facility Contact: �S LCI�n� Title: Phone:
Onsite Representative:
G
i
Certified Operator: 1�_ Y)I% S� f
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ( %
Certification Number: [ r 5YI
Certification Number:
Longitude:
Design CurrentDesign
9 Cterrent Desi Current
gn
Swine Capacity Pap.
Wet Poultry,Capacity�Pop. Cattle Capacity Pop.
.;i
Wean to Finish
La er airy Cow
Non -La er Dai Calf
= Da' Heifer
Wean to Feeder
Feeder to Finish
rZ
Farrow to Wean
` Design =Current D Cow
Farrow to Feeder
D , P,oul Ca aci Po Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Farrow to Finish
Gilts
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 No ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
0 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
[:]Yes " No
❑ Yes [�j No
2?NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

F'aciliNumber: - 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 V9 NA ❑ NE
Struc re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37JI
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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
to
9. Does any part of the waste management system other than the waste structures require
❑ Yes r7j 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.
y
❑ 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 Clop Window ❑ Evidence of Win¢'Urift ❑ Application O tside of Approved Area
1, 1
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
W-SHINIMMM, Mwm�mm'VA
L/ /A,
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
050
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
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
Comments (refer.to question #): Explain any YES answers.:and/or any additional recommendations or any other comments:gzt
Use -drawings of facility to better explain'situation`s (use4idditional pales as necessary) ,i�Z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �[d�3�-33CD�3 >'33z�D
Date: ! aGJ
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1 Departure Time:County: "am Region: FQQ
Farm Name, OwnEmail:
Owner Name: 1pr?549QrrtS
� Phone:
Mailing Address:
Physical Address:
h
Facility Contact: JQ F'Y�PS 1—�-.� Title: Phone:
Onsite Representative: Integrator: prLSrQ_ -
c
Certified Operator: Jam1 e JWI A Certification Number: _9QQS
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Cprrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
La er
Non -La er
-
D ' Cow
Da' Calf
D ' Heifer
Farrow to Wean
Z
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
D Poul -
La ers
Non -La ers
Ca aci
Po .
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other :..
Turke Poults
Other
1, ther
Discharrres and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Pg No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
W NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ 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 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

[Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ID No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Vg 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
g] 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?
1�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )U 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 ' d Drift
ee]}of Approved Area
❑ Application Outside
12. Crop Type(s): �S
�i� - V7 r
13. Soil Type(s): GOA I Ll
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes $M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[—]Yes 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?
T`
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �9 No ❑ NA ❑ NE
❑ Yes LM No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes T[d No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �,jj 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
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes - No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

TFacWty Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
(� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
(ja No ❑ NA
F
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FM No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to questronr;#) Explainany YES answers and/or any additional recommendations or any otber comments.;
Use`dra iwgs:of.facility to be#ter eapialn situations'(use additional'paQes as aec ssa y) ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:9% t�
Date: ITIZ
3 s
21412014

or visit:
for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: t r Arrival Time: [ 2: &I, Departure Time: p !tQJ County. Region:
Farm Name: ��p -- V Owner Email:
Owner Name:e Phone:
Mailing Address: _
Physical Address:
Facility Contact: =_ aQa5L, ( 0_nNN� Title: Phone:
Onsite Representative: o_M�S � � Integrator: �I(Csvo_nm
Certified Operator: v Certification Number: g� �yf
r r�
Back-up Operator: -4Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean. to Finish
Wet Poultry
La er
Design
Capacity
Current r
Pop.
Design Current
Cattle Capacity Pop.
Da'y Cow
Wean to Feeder
Non -La er
W
Layers
jf!Non-Layers
Pullets
Turke s
Turke Poults
I 10ther
I
Design
Ga aci
Po
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Ocher
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 D)VR)
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
[]NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes [] No
❑ Yes ® No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ® NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [D 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 E4 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 Sneed maintenance or improvement? . ❑ Yes [g 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops 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
Ej No
❑ NA-
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

1 /
Facility Number: jDate 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [P 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes KM No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
mmendations :or
Phone: 9 0 — -_3V00
Date: fL
21412014

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 0 Denied Access
Date of Visit: 1, 1 Arrival Time: b +y1 Departure Time: . oo ,, _ County: 13DIDIS�tJ Region: 17700
Farm Name: Owner Email:
Owner Name: iM S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
i
Onsite Representative: Q Lai, b
Certified Operator: `jQMI
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: s
Certification Number: / I D
Certification Number:
Longitude:
Design Current
*,z*
Design
Current
Design Eurrent
Swuee
Capacity Po
Dacl
M W14-ftli
C'apaclty Pop.
Aer
Wean to Finish
La
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
S
_
Design
Current
Dry Cow
Farrow to Feeder
D : ` Poii[
La ers
Non -La ers
Pullets
Turke s
Ca aci
P,o
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[71 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facifi Number: - Date of Inspection:'
[Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
C] 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
/11
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y.34
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 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
ja No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window [] Evidence f Wind Drift ❑ Application Outside of Approved Area
�k
12. Crop Type(s): �5� [j� GtS� �[ ,S � �` li .
�� p FF r� ttp
13. Soil Type(s): C'� � LL1 _
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 T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EP 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 [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection: 1j Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document E] 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 the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes rM No ❑ NA ❑ NE
❑ Yes [ No
❑ Yes ® No
[:]Yes [] No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments } ,
Use drawings of faeility:to, better explain, situations'(use additional pales as necessary)
.°..'4-
Reviewer/inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: IAP �34;
Date: 1/2 ff y
21412011

hype of visit: 0 Compliance Inspection V Operation Review U Structure Evaluation (> Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 9�/�1 Arrival Time: Departure Time: County: BLAOC3J Region:
Farm Name: Px _ Owner Email:
Owner Name: �i�sTAGL S Phone:
Mailing Address:
Physical Address:
Facility Contact: RQ1' 1, Title: Phone:
Onsite Representative: 51�25 Integrator: Tre 5AEL9.e
Certified Operator: Tu`Q �i��-iCertification Number: Wo,5y r
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current DesignCurrent Design Current
Swine Capacity Pop: Wet PoultryK,@apacrtv�`Pop Cattle Capacity Pap.
Wean to Finish La er DairyCow
Wean to Feeder Non -La er DairyCalf
Feeder to Finishy,FT., Dairy Heifer
Farrow to Wean 'y Design , Cu ent D Cow
Farrow to Feeder Orly P�ouIt , Ca aeI � Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s .
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 P No ❑ NA ❑ NE
❑ Yes
❑ No
[�) NA
❑ NE
❑ Yes
❑ No
E� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P 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
Stru
tore 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
F,
❑ 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
0
❑ 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
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 ® 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
❑ Outs' eptable Crop Window ❑ Evidence of Wind Drift ❑ Applic 'on Outside of Approved Area
12. Crop T s : C���t(s
13. Soil Type(s): Cn!Xk t-Lh - �) ck'1� Ann ket f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R3 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
M9 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Faci4ty,Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No 0 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
[—]No
® NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes J�] No ❑ NA ❑ NE
❑ Yes C@ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
`P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
®No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
Comments'(refer to question # ): Explain any YES answers. andlor any additional recommendations or'any otEer�commeats.
rY
tobetter.explain situations necessary).Lse,drawin s offcir
Fec"
►/Arf oa �1-0s- -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %1D _ 3.3-
Date: Tq19
-r
21412011

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
� Date of Visit: Wf) Arrival Time: Departure Time: Q r1 County:
Farm Name: Q Owner Email:
Owner Name: ivlsr Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ----� ``` re`: Title: Phone No:
Onsite Representative: -La q,6 Integrator:2i!���
Certified Operator: t e >V Operator Certification Number: q9DSV
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o =' = Longitude: = ' =' =
Design
Swine Capacity
Current Design
Population Wet Poultry. Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
Dry Poultry
❑ Layers
❑ Nan -Ls ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Dry Cow
Farrow to Wean '75
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
El Non -Dairy
El Stocker
ElBeef Feeder
El
El Beef Brood Co
tructures:
❑ Other
❑ Other I
Discharees & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No YINA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No ERNA
❑ NE
❑ Yes [ 9 No ❑ NA
❑ NE
❑ Yes WNo ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

S
z
FaciEity Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
9No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
(PNA ❑ NE
Struct e l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
ElNA [INE
(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
Q9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tpNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ -total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence ofWind Drift [I Application Outside of Area
12. Crop type(s) � (�?2 G ),
51-k �y�i.;
f L®G(S PKI' l7'Ya"Csw
r
_
13. Soil type(s) C7b 4 1 &
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(A No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
q No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
O No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA ❑ NE
y_.�
nts (refer to quest,on�#) ,Eaplatn,ao YES answers and/or an . recommendations or any othe_rgcomments
Commey�.._ F y
. .
Use drawings of facdtty to better explain situations. (useaddihonai pages�asssary)
4
-
Zei//o
AL
Reviewer/inspector Name `(G; c �( 4 phone: L? Y3J 'SSL»
Reviewer/inspector Signature: Date: 30 c0
Page 2 of 3 I2/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ 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
[9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IS No
❑ NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
1
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
QgNo
❑ 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
T No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
Addit! on.al.;Comments andjor Dran'ings
..:
AL
Page 3 of 3 12128104

Cf
10
1
,. .: =jOb
aq` v Q Division of Soil and Water Conservation
Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time lLi0 Pt*k 1 Departure Time: County:
Farm Name: I.POwner Ismail:
Owner Name: f ..�stG _ Phone: _
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:5_at'..R_.s Lath ,t; Integrator: C� Certified Operator: eQ� Operator Certification Number: r r
r r 16 _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = I =" Longitude: [� ° Q d =
di
Design C►urrent
Design
Current
Design Current
Swine Capacity Population
R'et Poultry Capacity
Population
C*ante Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
❑ DairyHeifer
❑ Feeder to Finish
CK Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Turkeys
Other
❑ Other
❑ Turkey Points
❑ Other
Number of Structures:
Discharpes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[RNo
❑ 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
ANA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: 44— Zl_jDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes. is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure a
ldentihzr:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)-.
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [VNo ❑ NA ❑ NE
❑ Yes [:]No [r NA ❑ NE
Structure 3 Suuctur, G
❑ Yes �9 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 MNo ❑ 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 No ❑ NA El NE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? Yes o ❑ NA El NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/imp'rovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes §a No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ NA ❑ NE
❑ Yes 5�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Oa No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
Eo--No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
MNo
[I NA
[I NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
V 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: U"i 55--fscv
Reviewer/Inspector Signature: Date: 9
12128104 Condnued

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 appropirate box.
❑ WUP ❑Checklists [I Design El Maps El Other
2 t. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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
R] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
aNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ 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
ONO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
WNo
❑ 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
PNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C�No
❑ NA
❑ NE
Page 3 of 3 12128104

— � Division of Water uality
Facility Number 3 Dinsron of Sail and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Fol€ow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: c.•,� n1 Departure Time: County: B L~-A" Region: FRO
Farm Name: f —it) Owner Email:
Owner Name: 2ms�C-L- Y�er Phone:
Mailing Address:
Physical Address: /�--
Facility Contact: T Title:
Onsite Representative: S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone •
.,
No
Integrator: Bng ��e .
Operator Certification Number:
Back-up Certification Number:
Latitude: =]' =" Longitude: = ° =' =
Sege
Design C►UU:entl
Capacity Population
Design Current Design
Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
airy Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ N ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Qther
❑ Other
❑ Beef Stocker
El Beef Feeder
Pullets
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
❑Beef Brood Co
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 F9 No ❑ NA ❑ NE
❑ Yes
❑ No
PONA
❑ NE
❑ Yes
❑ No
r NA
❑ NE
FNA
❑ NE
❑ Yes
❑ No
❑ Yes
VFNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 2— 139
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ANo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
NA ❑ NE
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 EpNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ANo ❑ 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 14 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No
El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
ElNA ❑ NE
maintenance or improvement?
to
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[jgNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
�
12. Crop type(s) sa u �-fctS�)`-�Q; m..[,z "s5 6sj_,�
13. Soil types)dOt3fD — "A-yyC�%
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No
El NA El NE
17. Does the facility lack adequate acreage for land application?
[IIfs Yes
QED
No
❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
119 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES':, aU.swers-and/or any recommendations or anv other comments
`:. g ional pages as necessary) . f
acil� to better explain situations (useaddtt x Use drawings of f ty p
Reviewer/Inspector Name T f Phone: g/D Y33'_T3g0
Reviewer/] nspecto r Signature: klAla.UA Date: Z7
Page 2 of
12128104 Continued

Facility Number: — Date of Inspection ! r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes kwNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 15 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
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U!�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
OQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
In No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
09 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
" No
10
❑ 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
PNo
❑ 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
29No
❑ NA
❑ NE
Page 3 of 3 12128104

M
L Division of Water Quality
Facility Number Division of Soil and Water Conservation
0 Other Agency
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 O Other ❑ Denied Access
� County: iorT:`� Date of Visit: to Arrival Time: �'h� Departure Time: t}': Reh�
Farm Name: k 0 _ Owner Email:
Owner Name: _'Off-� &dln S _ Phone:
Mailing Address:
Physical Address:
<-PFacility Contact: &tg Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Sine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= 0 0 A 0« Longitude: 00=1 a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
~-1 ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
�NA
!l❑
[I NE
❑ Yes
[:]No
El YesrNo
o
NA
El NE
El Yes
El NA
[I NE
12128104 Continued

Facility Number: � —
Date of Inspection U1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
It
❑ Yes F No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
to NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J@ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(9 No
❑ NA
❑ NE
(Not a lit -able to roofed its dry stacks and/or wet stacks)
Pp p
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 [ANo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0iNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) f-_,eSCue �-IY cM S GU,
13. Soil type(s) K__:1 0
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
1P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A 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/lnspector Name Caosm jam"' ly AULF Phone: 9 f O 4-33 33au
Reviewer/inspector Signature: Date: _2'
12128104 Continued

Facility Number: — Date of Inspection d7
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 P No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�1A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[:]Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
19 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl 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
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
1�jNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V9 No
❑ NA
❑ NE
Comments and/or
12128104

I
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ft
4 Arrival Time: �J � Departure Time: County: ' Region:
Farm Name: ( 0 _ Owner Email:
Owner Name: Pres4aAe Phone:
Ili
Mailing Address:
Physical Address -
Facility Contact: j�,,, �� �' r Title:
Onsite Representative: ►-�'U'�'i� o4--
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
p
Integrator: f oe-Sta5c -
d- _
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o = = Longitude: 0 0 ❑ 6 =,u
Design Current
Design Current
Design Current
Swine Capacity Population
NEU
�'�'et Poultry
Capacity Population
Cattle Capacity Population
ElWean to Finish
❑ La er
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Wean to Feeder
❑ Non -Layer I
ElFeeder to Finish
31 Dry Poultry
jo Farrow to Wean
El Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Beef Brood CoLAJ
El Boars El Pullets
❑ Turkeys
Other
❑ Other 1
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
ElYes
MIN.
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
MA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Cq'f4A
❑ 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
P-11A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U2'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�Ko
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: _ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
, ,,
L`_ <o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0 N
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EI'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
VNo
❑ 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?
[3 Yes
DNreo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
//
Eg o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tf No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C4
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 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) BG', G- SG GftYia-4-
13_ Soil type(s) Gvlk
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
UNo
❑ NA
❑ NE
dNo
❑ NA
❑ NE
k"No
El NA
El NE
No
❑ NA
❑ NE
�eo❑
NA
❑ NE
;Comments (refer. to question #f): Explain any YES answers and/or any'tecommendations or,t;w,y other come nt�
Use,drawings of facility to better explain situations. (use addtfional pages as necessary): W , �rG�ry,
Reviewer/Inspector Name b[P Phone: 10' 3-33ZO
ReviewerA n spector Signature: Date: �?� _ _
Page 2 of 3 12128104 Continued

Facility Number: ff— Date of Inspection
Required Records & Documents //
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes '2'A10 ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®Ko—
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
i
o
❑ 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 El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
(ld No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1,9'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
�zo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,35o
LV� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l9<.
❑ 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
ETNo
❑ 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
ElYes
CEKo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
KNo
L`7
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments°and/or Drawings:`."
Page 3 of 3 I2128104

D
Type of Visit 4D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 18 1 arVc_r.7
Farm Name: P'tL. — 1 O _ Owner Email:
Owner Name:. Pre_4x fcc c _ ����nc.s - Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Rkn J,,
e—
Certified Operator:
Back-up Operator:
Phone No:
Region: _'_P
Integrator: f "rc5A-aa C
Operator Certification Number: 17 7 cr6
Back-up Certification Number:
Location of Farm: Latitude: =" 0' 0 u Longitude: 0 o I--]' EJ u
Design Current q Bestgn Current � � . t z r� .� t� V Design Current
ME]Weanlation hWet Poultry rt Capattle ,= Capacity Population to Finish ❑ Layer El Dairy Cow
P
n to Feeder ❑Non -La ei ❑ Dai Calf
er to Finish 7'` DairyIleifei
w to Wean .ia? j g Dry PotEltrS'` } y ❑ D Cow
to Feeder`° ❑ Non -Dairy
❑Farrow to Finish; ❑ Beef Stocker
❑ Gilts " ❑ Beef Feeder
❑ Boars ❑ Beef Brood Cowl
l+
EEO
ther Other ;lvumber. of,Structures:EEI
❑ Layers
❑ Nan -La ers
❑ Pullets
❑ Turke s
❑ 7'urkev Puuets
❑ Other
Discharges & 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
-❑ 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
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Ifacility Number: 9 — /39 Date of Inspection 1G aJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (36 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:
-- 4 }
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Qfl No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
51 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
© No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
En No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s) &-tr-
13. Soil type(s) (� o la
14. Do the receiving crops differ from those designated in the CAWM P?
❑ Yes
[M 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
Q No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XI No
❑ NA ❑ NE
t 8. Is there a lack of properly operating waste application equipment'?
❑ Yes
[2 No
❑ NA ❑ NE
/s TA c ovcv-oe C (('++r ceoQ� 14.c5
G r w. �� 4 At- v _� \ D w,"-,l h
�o � r G ►�+ O v� -� a �, j 1 c� w �� �
Reviewer/inspector Name .!< a.L� - .5 � ,, `' Phone: '!
Reviewer/Inspector Signature: Date:
12128104 Continued

,l+acili Number: Q — /
3q Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP
❑ Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check tt a appropriate box below. El Yes [� No El NA El 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
M No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
eNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
Q"NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ED No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ENA
❑ 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
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
U] 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
[K] No
❑ NA
❑ NE
12128104

M
(Type of Visit 0 Compiiance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune: ��
�— r4$IR—atOperational Q Below Threshold
Mfermitted ['C-ertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: - - ----- --
Farm Name: O _ _ County: /_ F__�. j2
11
Owner Name: cs 4to c___ -- Fe, �+LL�._ . _. Phone No: S'Z'7
,. .
Mailing Address: P 0, 60x y31? .&C __g 2 S
Facility Contact: .W.RandU �AeEfoa:LTiitle:Phone No:
Onsite Representative- _ Ra.611 iL Integrator. &e_ s J�a A
Certified Operator:,•,,,•,,. Ga10! /Vea Operator Certification Number.
Location of Farm:
C!
[-trine ❑ Poultry ❑ Cattle © Horse Latitude • � �" Longitude •
Discharges - fitream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes a<o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes R<o
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 gKo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Bi o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O-Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
ldendfier: - - i
❑ Yes 2Vo
Structure 5 Structure 6
Freeboard (inches): '
12112103 Contbuied

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
40
seepage, etc.)
6_ Are there strictures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
�^
7. Do any of the structures need maintenance/improvement?
❑ Yes
Lf fo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
[2^0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes
2'Fo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[}M
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
o
❑ Excessive Ponding ❑rPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type _Eescu� . lrrelre �. era, rt�u Grws� S".11
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ErNo
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
QNo
16. Is them a lack of adequate waste application equipment?
❑ Yes
01`To
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:I 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 EM
19. Is them any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes B-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 ENo
Air Quality representative immediately.
❑ Final Notes
Rer-W,1 r C ✓"C 6" % •0.7 //' 3 ex 11
Reviewer r Nam
/Inspect° a�-
ReviewerAnspector Signature: %&1&1� R _ Date. 1.7 • ,� - U `7
12112103 Coniiuued

' Facility Number: cl— Date of Inspection Z
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
BNO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
[}i�o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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
[}lqo,-
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
0-90'
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
Oet discharge, freeboard problems, over application)
❑
Olgo
27. Did Reviewer/inspector fail to discuss reviewliinspection with on -site representative?
❑ Yes
MNo'
28. Does facility require a follow-up visit by same agency?
❑ Yes
�To
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑Wb-
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Q Y;s ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ago
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes QN
34. Did the facility fail to calibrate waste application equipment? ❑ Yes O-K
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ONO
❑ Sue -- 1 -'- C-2 F M E34LWnfall ❑
12112103

Date of Visit- 'ime: O,� �
Facility Number
�Not erational 0 Below Threshold
Permitted © Certified © Conditionallv Certified © Registered Date Last Operated
or Above Threshold:
Farm Name: 0 County:
Owner Name: 2 rr-r S Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0• D u Longitude • 0
Design-.` Current
Desiign Current Design Current
S�stee w ` - :Ca achy _Po elation
` _==Ponitrti spiv>=Po eilatidn.. 'Catde _.'Ca actri..Pa riia#6n w
❑ Wean to Feeder
" ❑ LayerDairy
El Feeder to Finish
F
`-° ❑Non -Laver I JQ Non -Dairy
Farrow to Wean
= _ ..-_ _
Farrow to Feeder
eo
r- El other t r
❑ Farrow to Finish
Ttl#il DesjgfiCa�BCttj r: r '
Gilts
€ __
❑ Boars
- Total SSLW
'ems
-
' _. k'. _ 4e
s ; ❑ S ray Field Area
Number of Lagoons ❑Subsurface Drains Present ❑ L non Area
Holdtag POW/ Solid Traps '.., w
- ` ❑ No Liquid Waste Management System
Discharges 8c Stream Impacts
1. Is any discharge observed froth any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes
�No
❑ Yes
A No
ElYes
o
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes
Structure 6
Continued

Facility Number: Date of Inspection sLL�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑YesNo
seepage, etc_)
, 1
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
El yes
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
o
Waste Application
TNo
10_ Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type ,� S.s,
13_ Do the receiving crops differ with ose designated in the Certified Animal Kaste Management Plan (CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
El yeso
b) Does the facility need a wettable acre determination?
❑ Yes
INo
c) This facility is pended for a wettable acre determination?
❑ Yeso
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
lkNo
Rewired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
)�VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[:]Yes
ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
4 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
qNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
24. Does facility require a follow-up visit by same agency?
ElYes
ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JE!&
No 0olations or deficiencies were noted during this visit. You will receive no further correspondence about this visit-
ZI
Comments (meter to question ##) Ezplain "ri YES' audlor an} raeomtnendat.ous or anycomments. z Ftzi
.other
Use drawings of fatuity to`better explain situateotts.. E� additzonal pages as neeessarv) Field C Final Notes
F
Ri gal
�/'� l4alCS �dDGY.
r
Reviewer/In spector Name `. _
Reviewer/Inspector Signature: Date:
05103101 tv
Continued

J
Facility Number Date of Visit: Time:
_j 10 Not Operational Q Below Threshold
U Permitted Q Certified 13 Conditionally Certified [3 Registered Date Last Opera7r Ab ve Threshold: . .
Farm Name: County:......1.�...p...........�. . .
Owner Name:�.P1~�..............�.r.............. I ......... ................. Phone No: ...................
Facility Contact:
Title:
Phone No:
MailingAddress: ....................•---...............................................................
..................
....._....
.....
W W ....... ._ _ .
Onsite Representative:.. ,�
......... 1_ e� Integrator:..__ ....
Certified Operator: ..................... ..................... .......„... . Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' A& Longitude • 4
T Dena Cur
Stiviae :Capacity, Po :n]
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design = Current ' ri - Desrga , Cueso
POttltry Capacity-; Population on, Cattle Cairac* Populittlt
Namber of ooms s ❑ Subsurface Drains Present Lagoon Area ❑ Spray Field Area
�.
Ponds / Saud T ` drag ^ raps,; ;, ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
IyNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed. what is the estimated flow in 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
o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
qNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................
Freeboard (inches): 3 7
5100
Continued on back

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 4No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ZV No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes J�No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes allo
11. Is there evidence of over application? ❑ Excesfive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 1� No
12. Crop type ud Ze?SC 6r r'
13. Do the receiving crops differ with those designs in the Certified Animal Waste agement Plan (CA WMP)?
❑ Yes
(� No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Q 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
E�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
lNo
21, Did the facility fail to have a actively certified operator in charge?
ElYes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ANo
24. Does facility require a follow-up visit by same agency?
❑ Yes
DNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O�No
Ila No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
$cwA. w. : me 2e su,., s --
iGomments (refer to,quest�oa #I) ExpWfi, ny YES aass�ers and/orany�recontmeadahons or any otter comments
'-
Ili drawmgsl,of facdtty to+better. explain situations (use'addtttonal pages necessary) y
1. I[:] Field Cony
❑Final Notes
fi 'w e- _ 1_Id n 4.,1-100 ks fovd- .,( Ii�' L 1
kw Y r' � SC�e (ice �d! (. " S� !yl Arc-61XJ
a ���r d��e
e9V-ef'0-114r)jt lCV k s � �!
Reviewer/Inspector Name I
Reviewer/inspector Signature:
O5103101
_ 2-F
Date: 3
Continued

Facility Number:O — 3 I Date of Inspection
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
V!kYes ❑ No
❑ Yes ANo
❑ Yes A�l No
❑ Yes )eNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
05103101

of Visit OCompliance Inspection O Operation Review Q Lagoon Evaluation
for Visit ® Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Hate or�'isit. �% // dl Time: y= 1JO
Facility Number Q /
Q Not Operational O Below Threshold
W Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold :.................-....--
��]] Count����
Farm Name /.....t1-..... f? y ....................................... ....................... ......
.
.......................................................I.....----••................
Owner Name .Gsc—t Phone NolD [ ................................................. S 7
Facility Contact: .. ........ .. ......Title: Phone No: .......................................... .......
Mailing Address: ...... -.. ,,1,-....r3 ...�1f ........ill. ....... ................ ...........................
Onsite Representative:...... Integrator:......
Certified Operator:.,•..•••• �q�. •..._,, lY ,- - Operator Certification Number:
.................................•......._ _...................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6, Longitude ' & 0:4
Design Current Design Current Design Curt
Swine Capacity Polliullation Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer :::]a Dairy
Feeder to Finish ❑Nan -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
MI Gilts
Boars Tota1!SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
- __..
Holding Ponds /Soled Traps ❑ No Liquid Waste Management System
Discharges R Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes 'KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -nude? ❑ Yes (RNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes tjjtNo
c. If dischame is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes RNo
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 P No
01/01 /01 Continued

Facility Number: OF —
Date of Ittspection / �!
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Rio
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches)= ........ ..2.�......................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes R No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ,l$No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level
elevation markings? ❑ Yes E[No
Waste_ _Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes R No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type
11 Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;$No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes JRJ No
15. Does the receiving crop need improvement? AV Xyes dEM60
16. Is there a lack of adequate waste application equipment? ❑ Yes X No )
17. Are rock outcrops present? d ^)A
18. Is there a water supply well within 250 feet of the sprayfield boundary?
El
Required Records & Documents On -site ❑Off -site
❑ Unknown B-Vv -&No A114
19. FaiI to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wcheck�ists, desigrktiia etc.)
P✓✓
❑ Yes
�No
r/ A___
21. Does record keeping need improvement? (ie/ irrigation, freehoard, waste analysis & soil sample reports)
❑ Yes
� No
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes,
01 No
23. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JXNo
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Wo
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[5tNo
26. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ff No
Odor Issues
28. 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?
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
KVo
01/01/01
Continued

Facility Number: O — /J—;P Date of Inspection // Q/ Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
31, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ( No
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FNo
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name _� ,;; _ k is •
Reviewer/Inspector Signature: Dater
01/01/01

l '
77
A Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date or visit: Time: �� Printed ern: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted © Certified Q Conditionally Certified 0 Registered Date Last Operated or Ab ve Threshold: ----•..........•-
pp
Farm Name: l.... 1.� County:..... �0......%........................................
/........................................................................................
Owner Name:...... 5. Ccrtrr!�1.I....... Phone No ............................
Facility Contact: ............f1� Title. 1.'. Phone No: ...................................................
Mailing Address: ............... ..........
Onsite Representative: ,,,/ blrc�;4.1— .„ Integrator:
.........................I.....-----....,,........................ .......................
Certified O erator:_.��.1°..................... /.V.�'�-� �...............---.................... Operator Certification tiumher:.......................... p ................
Location of Farm:
FM
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse latitude �� �� �" Longitude
Design Current. Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder Z ❑ Other
Farrow to Finish Total Design Capacity 2.
❑ Gilts
❑ Boars Total SSL W
Number of Lagoons ❑ Subsurface Drains Present Lagnlan Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste ;Management System -
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated slow in galhnin?
d. Does discharge bypass a lagoon system'' (Il-yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Struc;turc: I Structure 2 Structure I Structure 4 Structure 5
Identifier : ............
Frechoard (inches): Z
5100
❑ Yes ff No
❑ Yes No
[]Yes No
❑ Yes qNo
(:]Yes Jallo
❑ Yes PNo
❑ Yes 9No
Structure 6
Continued on back

_f
Facility Number: ©/ -/j9 Date of Inspection /S-aa Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes No
(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? 5(Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Po
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes $11�0
Waste A lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes (�No
11. Is there evidence of over application? ❑ Excessive Pondiinn�g ❑ PAN ❑ Hydraulic Overload ❑ Yes WO
12. Crop type4G�te t/ftZe /JPrnrc+ V/ �QzB f- i��Q.�
13. Do the receiving crops differ with those/esignated in the Certified Anint�fl Waste Management Plan (CAWMP)?
14- a) Does the facility lack adequate acreage for land application? /�
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
: Nd •yiolati iris or defcienc;es -were noted- diWirig this visit; - Y:o>ir will receive Rio: #'ui•th r:
corres• orideirce'about: thisv'sit......:•:•:•:•:•:•:•:•:-: ................
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explaainy7 situations. (use addition/al pages as necessary):
❑ Yes ONO
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes f"No
❑ Yes A No
❑ Yes WNo
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes 1� No
❑ Yes J� No
❑ Yes _ \\§�No
❑ Yes P"O
lReviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: ��—� 5100

it
IFacility Number:vr q -13 Date of Inspection 1 0 /'., �'u Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge tit/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes q No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes r
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Ir
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 19�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? R�es ❑ No
5100

w 13 Division of Sorl aii&Water Conservat,on Operation Review F
�' r] Ihyision of Soil andwWater Conservation `Compliance Inspection Y
Division of Water Quality, Compliance Inspection Y '.max r
:.
�Y Other Agency Operaho�Review' _ - —
A
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number o y Date of Inspection
Time of Inspection 2: 24 hr. (hh:mm)
® Permitted ® Certified © Conditionally Certified 0 Registered [3 Not Operational I Date Last Operated:
Farm Name Rr. /d County:......_....Z1'c'...............................................
.......................
Owner Name:..........! .t'�iE�ar-�1........r,�!�................ Phone No: ���0� �12 • d"7%f .._.................
L _...
Facility Contact: .✓ ... 1f:WeX..AA ...... Title: Phone No: ...................................................
Mailing Address:......... �..±�� t ..../.c.l.t .....(.�l.G. i•� (V G z r7Q3 Z..l......................................................... ..........................
Onsite Representative :.....A9.....z.7....... fl!1?".7f...................................... Integrator:......................................................................................
Certified Operator:......... ......... > A' ....................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude 0 & Longitude • & 44
0
--Design Current:' =- Design . ', Current; Design _ Currerit,
.-Swine ,.P
":Cat : .ty Po ulahonoultr3Cpacy.pan. e -Capacity Populaion
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gifts,
❑ Boars
Number of Lagoons, , ❑ Subsurface Drains Present ❑ Lagoon Area 10Spray Field Area
HoldikPonds / Solid Traps ❑ No Ligaid Waste Management System
_ ,. _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: [ILagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes ff No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) []Yes i@ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Deter- 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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,KNo
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 y
Identifier: r
Z �
Freeboard (inches): .........t2................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes kNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: Li S— Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
�Do any of the structures need maintenance/improvement? Yes allo
8. Does any part of the waste management system other than waste structures require maintenatce/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes )KNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes / ` No
• H. Is there evidence of over application? ❑ Excessive Pofnding ❑ PAN
❑ Yes XNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes KNo
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes KNo
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes &No
IS Does the receiving crop need improvement?
or?es P'No
16. Is there a lack of adequate waste application equipment? klr^yes )<No
_Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
tNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21 _ Did the facility fail to have a actively certified operator in charge?
❑ Yes VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 'KNo
. (ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes Cooes
7(��J
facility require a follow-up visit by same agency?
El Yes N
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
NO•V4Uiati6sis of detici6na s were jao p(l diti`lllg {flls.v. sit' - Ydit Wi. I-fee�lj'C il0 �ul"t�ltrr
r6iriS Oflde' ah"fthi V15'L. ''. . .'.'......._'.'.'.' .'.....'.' . . .
Comments'(refer to iii§ti6n #) =Explain any YES answers and/or any reconrimenilahons or_any other r meats _
M _ y.,..
7. � /..r.rr�.c �lo�.£ /�'As R �,�6/ •� �v,,/�C �%o ro�45;44Cr T07 A/�.G�
�l�ilh �i�ravw� �O o loeJ J
Reviewer/Inspector Name xt+� •, zSa.. �r is __tip s +
Reviewer/Inspector Signature: Date:
Ar-
3123/99

I�
Facility Number: 09 — rap Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
KYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
tx No
28-
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;KNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
ElYes
PrNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
NNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
ANo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Pj Yes
❑ No
- - = AAditional. amments an or.' rawrags: ,_ =r -'F = _
3/23/99

Division of Soil and Water Conservation Other Agency
C� Division of Water Quality'
10 Routine O Comulaint O Follow-un cif DAVO insmxtion O Follow-up of DSWC review O Other 1
Facility Number Q
13 Registered 8 Certified [3 Applied for Permit 13 Permitted
Date of Inspection
Time of Inspection 13: � 24 hr. (hh:mm)
113 Not O erational Date Last Operated :...............
Farm Name: - County:..........,£..J....................... ........ I...............
Owner Nane:.........Phone No: Sx.2r5V7112"r,....... --.... ... �.
Facility Contact: ........ 16.......... Title:.. .... Phone No: ............
Mailing Address:...------.:..�FJ...r ...Lll.:.....�<l!`/r �....a.�c0
Gf............:.
Onsite Representative:..,,,, �j � .�T .......... Integrator:......:f� ,
/ .G.. -• f - .................................................
Certified Operator,......... , i... IF ........................... Operator Certification Number......
Location of Farm:
Latitude Longitude �• �° 0"
�N r)esign Current Y Design t h ",£ Design ;;' Curent
.. _ `"Capacrty, Populadon_n
,.Curren
afoul#ry _ ..CapacityPdpnlation ., :};Cattle s'Capaci#y �Popufation
x ❑ Wean to Feeder
4F
❑Layer , ❑ Dairy
❑ Feeder to Finish
❑ Non -Layer ❑Nan -Dairy :
Farrow to Wean
.Other
Farrow to Feeder Z
❑
❑ Farrow to Finish
Total Design Capacity,
z,Gilts
,�
M X w
0 Boars
y •eas
x
. � Total
P
Niimber bf Lagoons 1 Holding Pond`s =�
❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Area
s
d W.......aste Mana ement System
❑ No Liquid
yn
General
1. Ate there any buffers that need maintenancelimprovement?
❑ Yes
fl(No ,
2. is any discharge observed from any part of the operation?
❑ Yes
M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M-No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
RNo
c. If discharge is observed, what is the estimated flow in gal/min?
/t%%i4
d. Does discbarge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
IgNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
RNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
gWNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
UNo
7/25/97
Continued on back

Facility Number: o — !3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons, Holding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):..............y'7........................................ .........
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?
❑ Yes XNo
❑ Yes CKNo
Structure 5 Structure 6
............................. ...................................
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 VR", or runoff entering waters of the State, notify DWQ)
15. Crap type �Ti++r1!P.F.. ���...-xC.l .......................... .
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?
I S. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only,
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?
........I ...........................
❑ Yes A No
❑ Yes tgNo
X Yes ❑ No
0• No.violations,or. deficiencies.were nated-during this:visif You:will receive,no,f&ther-:
:-:•cbrrespondencea�outthis:visit:•:•::_..::._:._.•::_:::,::.::::;.:_ ..::.....:::.::.:::.:..::::::.::.
❑ Yes ,K-No
❑ Yes XNo
❑ Yes P�No
❑ Yes ,g'No
Ayes ❑ No
❑ Yes ;kNo
❑ Yes XNo
❑ Yes OWNo
❑ Yes )KNo
❑ Yes ;KNo
❑ Yes No
❑ Yes P'No
E4mrietts (referto question #) s�E�plainfany YES answersan�lor ariyreromtnendations or any oIer corrrmeants. f °w
9E' f S wf
iUse tlt wings of faculty t() betteC explal[! sttuaadns =(iise addltional pages as necessary)
_ z :@�?v-..'�,.. ;'?'"` ,: �/,<1/w�b�h'-u.;�,
.4�+v, �..; zxw.a. 2F�n �,. W,�l+.'•diina. ?',. mow, Hr'4�, his �,i3, �..n'.�' tih 1.
/-:(srsi+<..f
�a�bY'syk�i/ffi':�s�
!¢
12,
W'VA /
7/25/97
Reviewer/Inspector Name otR
§f�
Reviewer/Inspector Signature: Date: �9` ��

Faddy Nxee:ber:
Division of Environmental Management
Animal Feedlot Operations Site Prsitation Record
Date• 2 -14 '
Farm Name: P X I U Comnp: I� ��,•,
Owner Name: s f4. 1= ,,.'^ s.�. Phone N6,4"'Vb) 5'9z - 5'77 !
On Site Representative:' �? Vic_ : Sa .,,d s.� -Integrator.-
Mailing Address- P O R a7c 46,31-
CG..,4. C- Zs 3 z- g
Pbysical Address/((I.//ocatiaa: tk-,� -z1 i fxc== C.3� + te � Q b�/,S _ T' #s 6�//.�
�F7i907iib a0.lSY855 kkf✓tk,TN Yf '+ ^gT•tyS
so
wona -. 40�111,1 k-,[- v--: i t v rl t c�J-
Qpesation D caption: (based on design characteria)
nvjM$ w No. of AnLwk. 7jpe of Poulby No. ojAnLmak Type of CC No. of Anima
WOW - G- �� (3 Layer O DI&7
O Nay Q Non -Byer O Beef
O Fftdm
Othe j7 pe of I w-vock 1Vimber of Annnah.
Number of Lagoons: ! {include in the Drawings and Observations the freeboard of each lsgoaa)
FaciT try Inwkwan_
Lag"n
Is Iagoon(s) freeboard less than l�foot + 25 year 24 bour storm storage?: q3 f'� Yes O No C3'
Is seepage observed from the lagoon?; Yes © No 13'
Is erosion observed?: Yes 0 No 13,"
Is any discharge observed? Yes C! No Cr'
0 Man-eeade Q Not Mange
Co Per 0VP '
Does the facility need more acreage for spraying?: Yes C] No 8'
Does the cover crop need improvement?: Yes a No Cr,
lit the
crops which need infrPVCM )
Craptype'. s �� _ Acmp-,
-
Setback Cmeria , • Is a dwelling located withW 200 feet of waste appUcation?
Is a well located within 100 feet of waste ' applicatioa? - -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of BIue Linz Stream?
ADI — 3=um7 170%
Yes CI
NO L7 ,
Y. 0 �-,No
Yes O
No cr,
Yes O
No Cy
...r. ;---x-.... �-

Maintenance `
Does the facility maintenance need Improvem ? Yes O No B"*�
Is there evidence of past discharge from any part of the operation? Yes O No M-'--
Does record keeping need improvement? Yes 0 No Or'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes G--INo O
Explain any Yes answers +►� r� i s- Gd -� [ i L �t i S i e K� + t a� . �o toa.7r —. /
N 0112 U13�e 31 LIJ'7
cc FacairyAssessment Uhit . -
ir-awings of Obseryations:
Due- Z - / -,iL -F (e
UseAv"Amenu ffNeeded
- ... .. � _ �. ,••.;�• - :ice �_ ::.' •:.. _� _ ..:. '_
AOI - January 17.1996 - _ •;

Site Requires Immediate Attention:
Facility No. 9 Z - SiS
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - ! 9 , im
Time: / 3 : q- 0
Farm Name/Owner: _ X - / 4 f7rccr q e_Q v Aot.S I T,vc ,
Mailing Address: F0 go ar 4L3 S CI,'.v fo , f NC --
County-, t3/odc,v
Integrator: Phone:
On Site Representative: Phone:_ 910_) 59 7 - S 7 7 /
Physical Address/Location: SR - //7 7— o^-f Pw,141 .'-� .�.� H�•-y z t l _
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: / Z 4< $ Sow Number of Animals on Site: / z q- S _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hay sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No Actual Freeboard: 2 Ft. Inches
Was any seepage observed from the oon(s)? Yes ox!94as any erosion observed? Yes ox!V
Is adequate land available for spray? e r No Is the cover crop adequate? <I�Nr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
IO0 Feet from Wells? Qe or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes 06P
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes cqrNp
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(NP If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? r No
Additional Comments:
Chat. -It s A i vc r� s �� �'4..�,�-
Laspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. S L - S'/S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - (9 , 1995
Time: 13 : q- O
Farm NwWOwner:_ P X- / 4 l Pres-1aa& iC_a v A--L s -, T.vc
Mailing Address: Pn �00Xr 4L3 3 Ctflllvf011f Ne z 3 Z S
.County: r610de.v
integrator: Phone:
On Site Representative: Phone:_ 9/O _ S� 7 - S' 7 7
Physical Addressn ocation: S9 - //7 z Z . 4 " = s v•4 R,4Pre HW IF
z ! 1
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: / Z 4� $ Sow Number of Animals on Site: _ 1 z q- $
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude. °
Circle Yes or No
Does the Animal Waste lagoon hav sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)�or No Actual Freeboard: 2 Ft. O Inches
Was any seepage observed from the oon(s)? Yes o6-D4as any erosion observed? Yes odP
Is adequate land available for spray? r No Is the cover crop adequate?Qor No
Crop(s) being utilized: ,',�_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? Qor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 06P
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ctip
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(&�P If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? r No
Additional Comments:
ChaV!c-S Ica 1 VCI-e,S
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. 8Z- 6-1-5-
`Farm Name/Owner:
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - I g , 1995
Time:
/ 3 : 4L o
�a vas Tivc ,
:Mailing Address: PO i3a Xg-3 S C: N4a Ar Al C Z 3 2 S
;County: 0/1 1V
Integrator: Phone:
,On Site Representative: Phone: Z - S' 7 -7
Physical Address/Location: SR - //7 Z Z ~, /- s oni /y`ck{ flu-!2 z l l
PX-l0 / P.
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: / Z 8 Sow Number of Animals on Site: / z q- $
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hay sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: Z Ft. 0 Inches
Was any seepage observed from the l oon(s)? Yes o>�pWas any erosion observed? Yes 06P
=Is adequate land available for spray? e r No Is the cover crop adequate? (S�or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellines? or No
100 Feet from Wells? Y:e. )or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(&�P If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?<5i�r No
Additional Comments:
cha�­1,Ls A Ivc.re.s
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: PD
Facility No. ' Sz - 5/5
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 19 , I995
S6 `J
. Time:
Px- Jo c • i%
Farm Name/Owner:
Mailing Address: P, 0. Sox 9138' tVC. zg s z8
County:
Integrator: Phone: -7/0 59 z - 5-7 - !
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Z . 5- Number of Animals on Site: 2 x �2, Ll = .12 Y P
DEM Certification Number: ACE DEM Certification Number: ACNEW
latitude: ° ' " Longitude: ° —'—a
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (ja�or No Actual Freeboard: 2 Ft. Inches
Was any seepage observed from th lag_oon(s)? Yes orb Was any erosion ob. CC ved? Yes or�
Is adequate land available for s ray. Ye or No Is the cover crop adequate. Ye or No
Crop(s) being utilized: a- a -;)
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?
100 Feet from Wells? �r No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or IV
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
No
Yes oiR
Is animal waste discharged into water ofUbe state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No --
Additional Comments: 2
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

W
NORTH CAROLnM DIKPhRTMENT OF , REALTE b HAT[JRAL RXS0IIRCES
DMSION of EMMONXIMAL
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
'^^..`^•'« f-+o-- "::3.` .n.:.;'"r..:%.,�. '-_e.a,. -,'0ty..:"V x:t Cy <r:�: �:.
are+ 4.. ,., ltff% /���
'..mow �4... ^:� ^4±.'Y^ �.
:„:c'a.:.':,.:.:li.:i��;,/��ar>"•w,su•,'^.'a..>i.o�4. :'-:�swvy;.w�'"'.�c+�e i�?°M':.er«•,..^.::�
���+�•p��/� �■ 4s� �y��qp
'�^.�JiWrL411W.� :C'^.�iL�L7.� rv; `'
V1ft{i.«•:�'oY'•�tww'
]
�f�GT�r�� i�Y17aa:��:Y
I D Prey c, f:�u-rn s Inc.
xy..•. y v�.....•.�..•�/� y.�^Tn��� �.
i}...A.t. 4� :+4tt„.yi�.W
u�3�.��,J:•'��p�-�}«�/�►�;:��rp.>�..�yy�yp r.:'.MF ..,.�.-u*
Box 438 C%r kv) NIG z7252e
u -say -5771
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 Y
Animal 04eration . Type: Farm vi n J
Horses, cattle, swine, poultry, or sheep
SECTION IT
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 licjuid waste
System)3 _
2. Does this facility meet criteria for
Animal Operation REGIS�RA.TION?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIYIM AN�
WASTE MANAGEMENT PLAW
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 5CS minimum
setback criteria for neighboring houses,
wells, etc?
Y # N I COMMENTS
iaECEIVED
JUL si ,p'-.
ENV. MANAGEMENT
FAYETTEVILLE REG. OFFICE

RECrION III
i ld ite Nana extent
!. 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 leap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land applicatiou'site have a
cover crop in accordance'with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by maze -made ditch, flushing system,
or other similar man-made devices?
C. noes the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved TIFICATI
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
sg=ON ry
Comments

LANZ
`"-
•
�•
u,
l,, r` r�
7 VA .
06
I
!�
'a.
..a 1� f at � � ■
�
••►, ,. ..,,,.�._�
tip[
It
!A'GlcTARY
�f T
UU
UM4
f DIRECnONS TO PX-10 (ABBOTSBURG FARM)
From•Clinton take 7015 to Elizabethtown; go through town,
and turn right onto 242 W. Go approximately 3 1/2 miles
and turn left onto SR 1003. Cross over 211 and go
y
_a-
_
"� '' approximately 1 /2 mile; turn right onto GrinWey Farm
UM
,Road (SR 1172). Go about 2 miles; farm is on right.
My
r
10
Y4
s
�
Q'
C 0 t_ U M B U

REG1 c" t=s ZON FORM FOR ANIMAL -__Q07 OPERATION!
Department of Environment, Health and Natural Rescu_oes
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serve more than or equal to ? 00 head of cat -:,ye, 75
horses, 250 swine, =, 000 sleep, or 30,000 birds that are served by
a liquid waste systean then zhis fora! muss ;e filled out and mailed
ty December 311993 pu sua _ __ _„A NCAC 2 .02_7 (c) in order to be
deemed permitted by DEM. Please print clearly.
arM Nacne
Mailing Address:--'P, 0 ' f ox was
Wun zy:
Phone No.
Cwner (s) Name:
S
Manage_ (s) Name
Lessee Name:
=ar.m Location (Be as specific aS possible: =cad names, direction
;�; epost, etc.)rn� Lr_ARK�a�-? +��- 4Jkt'y1 All -VQ A-aCWs3cf;C� .
L at_c::de /Lcng:tu e if known:
Design capacity of animal waste managemy t system (Number and type
of c=nfined animal (s) ) _ "o j rRwo 1 _(,JEAN
Average animal paoulation on the _`arm (Number and type of animals)
-raise_)
- - yea=
Production Began: '
ASCS Tract No.:
3 a
Type
of Waste Management System Used:IUT4
TOOL
Acres Available for Land Application. of Waste:
Owner(s) S =gnat ,.re (s) .