090188_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

' g s f rA" -h9 t?c�
ORIS-ion of M.ater Resources
Facility Number - IWI
Division of Soil and Water Conservation
Other Agency
Type of Visit: ompl' nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: EXRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: g Arrival Time: Departure Time: ' County: cue ^ Region:
Farm Name: _ �� 6Z.[7'c'd 1, °"t?�� _ Owner Email:
Owner Name: R 2ti�2�U[2GC Phone:
Mailing Address:
Physical Address: ��/JJ
Facility Contact: C,,, i U�c�"L�% Title: Phone:
Onsite Representative: ( Integrator:
Certified Operator: t Certification Number: �,�� t- J
Back-up Operator: Certification Number: '
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Dal Calf
Wean to Feeder
o
O D
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
D . P,oult .
La ers
Non -La ers
Design
Ca aci
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes C HI-0 ❑ NA ❑ NE
a. Was the conveyance man-made? [—]Yes [—]No [] A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ N ❑ 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 Q o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes E(No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - $'' Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D_Nv--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3 A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ 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 Q No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E�-Nh ❑ NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7'N-o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes C211 0 ❑ 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 Gj- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or tO 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): —r - ;S Co C'
13. Soil Type(s): 96.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E `No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑Yes [DNo ❑NA ❑NE
❑ Yes E�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes [2-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 a —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 0 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 21412015 Continued

Faci la Number: Of - If jDate of Inspection: It, Keu,A' In
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L:J� ❑ NA ❑ NE
.`
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
U No
❑ NA-
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes o
❑ Yes a�00_
WNo❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Qi _ Date:
Page 3 of 3 21412015

hype of Visit: UCompliance inspection V Operation Review U Structure Evaluation O Technical Assistance
RI
eason for Visit: E) xoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: A`
Farm Name: ff PL
Owner Email:
Owner Name: L4qL15T I, (,7 0o ffer, _ Phone:
Mailing Address:
Physical Address:
Regionr-1 w
Facility Contact: i.L" ft 66o4 A Title: Phone:
I(
Ousite Representative: Integrator:fr—q4 Certified Operator: C Certification Number: T p/ 0
b
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
CYD_ 'ac I RM Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
lNon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current _Dry
Cow
Farrow to Feeder
D . P.onl
Ca aei
l',o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
IBeef
Feeder
91
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
NELOther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�]~o ��.P❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NE
alqA� ❑ NE
❑ Yes
❑ No
E]- NA
❑ NE
[:]Yes
a-?W
❑ NA
❑ NE
❑ Yes
[3'90
❑ NA
❑ NE
Page I of 3
21412014 Continued

F'acili Number: Date of Inspection: G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ZNA- ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes M>cr— ❑ 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 Lip!'" o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 �Io ❑ 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 �iGo ❑ NA
❑ NE
maintenance or improvement?
1 l . 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
f d❑
12. Crop TYPe(s): � C-IL T M' cy"Y C, S�„ ci
r
13. Soil Type(s): -p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U20No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [&<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [j o ❑ NA ❑ NE
[:]Yes [�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3'*�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[3"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
U]�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
a5No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
ONo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Sum her: -141 113ate of Inspection: OH
24` Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g�N5 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:I"I;ro ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E ❑ 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? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ii No ❑ NA ❑ NE
Comments (refer to question #). Explain any YES answers and/or .any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as'necessary).
Cif0 ('Ori I— qL(— 4J
S(U� It C_.� ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1_15_1�- 0-3.61 . P- q.0
[:]Yes P° ❑ NA ❑ NE
❑ Yes ['io ❑ NA ❑ NE
❑ Yes 01No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
Phone: 3` 3 S�
Date: Oct FV
21412014

r
hype of Visit: (-'rUompliance Inspection U Operation Review () Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: a Departure Time: ! p County: .-•_ Region:
Farm Name: Bpay
yi ��L �G _ Owner Email:
Owner Name: _ ay ;� � e^ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: a rI4.eosk— Title: �Kr� Phone:
Onsite Representative: Integrator:
401
Certified Operator: �s- Certification Number: 6 D Ai3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet PoWtry
Capacity
Pop.
Cattle Eapaclty Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder blotl 57 IMNon-La
er
Dairy Calf
Feeder to Finish
- .. '` .
.'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. PoWt , .
Ca act
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Cilts
Non -Layers
Beef Feeder
Soars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[-]Yes C3 No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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?
Y
Page 1 of 3 21412014 Continued

Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): y
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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CjgNo
❑ 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
�INo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [F�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): �,lJ'117 Oat- 119
13. Soil Type(s): jsj 6;f- f jt--- X
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fffNo ❑ 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 [kNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes RNo ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[4No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z, 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
[K No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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
5a No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
g.No�
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

to I Facility Number: - Date of Inspection: -- 6 —1,41
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CgNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cg No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
❑ Yes tA No ❑ NA ❑ NE
9�yes [ No ❑ NA ❑ NE
❑ Yes K] No
❑ Yes ®No
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 51'P-y33-33M'
Date:
21412014

irii-S ! Q s�Lq 1-1
Type of Visit: ,Q Compliance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
C� Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: `�'• {� a Departure Time:1 loodACounty: n_
Farm Name: e-y%A xj� Owner Email•
(i a✓i rt �
Phone:
Owner Name:
G
r oo e�
Mailing Address:
Physical Address:
Facility Contact: rjc9O Title:
Onsite Representative: tffi
Certified Operator: l
Back-up Operator:
Location of Farm:
Latitude:
Region: -
Phone:
Integrator: G
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
_
Design Current
Swine
-+
Ca act Pa ?Wet Poul#ry Capacity Pop.
P h P
Cattle Capacity Pop.
._, ,
Wean to Finish
La er
Dairy Cow
Wean to Feeder
O dC7o Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
�: Design Current*
Dry Caw
Farrow to Feeder
awouIt > Ca aci P,o
Non -Dairy
Farrow to Finish
a La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Gather
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 ofthe State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes
E3-N—o
0 NA
❑ NE
[] Yes
❑ No
NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[1 A
❑ NE
❑ Yes
[E-No
❑ NA
❑ NE
❑ Yes
[5"No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: q-lp Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ 'ro ❑ NA [ 1 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [a-16❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
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 [ -14o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes []f"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): ____g_ V at C_�k 9 & �D —
13. Soil Type(s): r D E'7
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes ,QTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�r`No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ o ❑ NA ❑ NE
❑ Yes [g-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:�'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
Ea 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
EfNo
❑ 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 21412015 Continued

Faciliti Number: - Date of Inspection: arc
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
[r3'No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[] 'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? :
❑ Yes
Q'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
C] Yes
C3-No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
DNo
❑ 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
[n�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
[r]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
E]-No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
[3 Yes
E]-No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
[]"No
❑ NA ❑ NE
se drawng1.
s:of,fac�l to, 60r,,,,eiplam=s Wations (use ad
�a
'ty ditioal pages as�necessa'ry).
C
UeA/
c<.II - Ito- 3t�g- (,&'Sf
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: I 1 d_q�
Date:
21412015

i
i
Date of Visit: Arrival Time: 'p D Departure Time: I I D : 00 1 County: 1 Region:
Farm Name: &171'7 I t-deG 7 Owner Email:
Owner Name: cI Jielic0� R Phone:
Mailing Address:
Physical Address: I
Facility Contact: � �� (��noLl_ Title: _ ��/` Phone:
Onsite Representative: �_ Integrator:
Certified Operator: 15r, - Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Ca aci Po
P ty F'
`,w 'D gn :Current
Wet Poul"Ca a°� Po
':�-;—P ry� p•
Design Garrent
Cattle Ca aci Po
P ty p-
Wean to Finish
La er
Dai Cow
Wean to Feeder
4�p
Non -La er
$'
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
t Design Current
Cow
Farrow to Feeder
D , P,o_u!t : _ 'Ca aci �;. P,o
Non-DaiTy
Farrow to Finish
Beef Stocker
Layers
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
- "
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 C&No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes 0,No
❑ Yes ELNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: — - 7 jDatc of Inspection: Of
r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in). _T_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i_e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
V1 No
Whi
❑ 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
CNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z 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
[allo
❑ 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?
1. 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 ❑ E/vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): �Ln2m �x ZEL11 12f/C�7S C.c1`-
13. Soil Type(s): _ 4_ l 1_�_ J—=x
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 121 No ❑ NA ❑ NE
❑ Yes [l,No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
[:]Yes
HNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
MNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
C] Yes
�Q No
0 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

• Facility Number: - Date of Inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
f 23. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes §jNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EkNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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 the 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
[R 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
O_No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES ans*ers-andlor any additional recommendatians o�,tany�ottier c(imments.._ r.
r
Use drawings ;of facility, to better explain situatjna ons (use additiol pages as necessary)
Reviewer/Inspector dame:
ReviewerAnspector Signature:
Page 3 of
Phone: 191I2—Z�Da
Date:
21412011

MU '_ 9 i r,e., ]', _
_ _ .� nAUII
�- [vision ofrWater Quality '.
Facility NumerC�'®,` [sZs[on ofaSoil,and Water ConseFvahi n=�
.§
Type of Visit: lam liance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: p [7 Departure Time: ; / County: lit
Farm Name: j n� ��fj� G� Owner Email:
Owner Name: DAY `Ih G-vad may, Phone:
Mailing Address:
Region: /6
Physical Address: ! +
Facility Contact: g:�j1 Id F\ C1s-oa Title: gVUJP1 e-Phone:
Onsite Representative: s .�_ Integrator: &__ _
Certified Operator: .$_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Destgn
Current
Desig��C rren
Design Current
Swine Capacity
Pop. -
�
Wet Poultry Capacity1Po
CattleJill =V60pnicity Pop.
La er
Non -La er
r
Design ,Cui rent?
DairyCow
DairyCalf
DairyHeifer
D Cow
rFeedertoFinisb
Non -Dairy
D r Pmoult, Ca aci 9,- Po
Layers
-
n
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Turkeys
Beef Brood Cow
y^'
�"p
Turke Poults
Other a
Other
Other'
inish
eeder
(pD�
Wean
Feeder
Finish
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes K No ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made? [3 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)
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 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: OkPi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes allo
a. if yes, is waste level into the structural freeboard? ❑ Yes [:]No
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(Z 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
Ca No
❑ NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ln No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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): Sr7_'W ItIA
13. Soil Type(s): �j--� X ��u A
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes [4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ca No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑C , 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 F7 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: a- Date of Inspection: rJ1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a No ❑ NA 0 NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [Z 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.
CS Yes
❑ No
❑ NA
❑ NE
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
❑ Yes
U No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to.goeAion.#): Explain any YES answers,.and/or any additional recommendations or any other comme6N.
Use,.drawin9S of facility to better:explain situations (use additioriaLpakes as:;necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

l ype of Visit (.)Compliance Inspection U Operation Review ("tructure Evaluation ,,U/�Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up • 0 Referral 0 Emergency QP(5 her ❑ Denied Access
Date of Visit: Arrival Time: f 3 Departure Time. c� . 3� County: ZLaL&t_ Region:
Farm Name:&-ji h �G-aL f _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ctu` ( r� Title: &:Un W f— Phone No:
Onsite Representative: Integrator: > th 1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = , = A, Longitude: 0 n 0 I = u
Design Current
Design
Current
Design Current
Swine Capacity Population
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
❑ Dairy Cow
Erwean to Feeder
6,06"D�
I
I[] Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
u
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[--IN E
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection — u
Waste Collection & Treatment
4. is storage capacity- (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
03-No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[9 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[allo
❑ 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
93 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA KNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
®,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) 3r:Y-" . / y
13. Soil type(s) b Za y ;,4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P,No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
B No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R_No
❑ NA ❑ NE
endnti
<Comments (refer to-queshon'#}:. Explain anvi,YES answers and/or any recamm ons oranv other comments.
Use drawings: of facility to better explainsituations (use�addttional pages as: necessary) -
T�� S ru -i for /f', f�rr bDa,-J rrt� '-7W d L". I e !(1 i �•^' a re � t�c�J '9
/`��rrrbo� too-3 dQK r, /a a4v �
aF
Reviewer/Inspector Nameu Phone:
Reviewer/Inspector Signature: Date: /
Page 2 of 3 12128104 Continued

a
Facility Number: Of —/ 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 Eallo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
S No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E,No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E-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
IN No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
E.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
B 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
[,RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional C6mmen4 and/or Drawings:
•
Page 3 of 3 12128104

"i'Division of Water Quality � - '
==7=.Fawci_1Hitumber 9 / O DI U—n— of Soil and Water Conservation j—I a
0 Other Agency
Type of Visit
IT —
Compli nce Inspection
0 Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
outine 0 Complaint
O Follow up O Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: �� Arrival Time: D Departure Time: l7 County: �- Region: E FF D
Farm Name: S"JIrtr-I'T— f �Ga G n/ Owner Email:
Owner Name: �n���� {?�OG�Ys^� Phone:
Mailing Address:
Physical Address:
Facility Contact: V" Title: 0U."�n e _ Phone No:
Onsite Representative: ��ts-ter _ Integrator: .�.
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' 0 Longitude: 0 0 = ' =
Design G•urrent Design Current
Swine Capacity Population Ftl Poultry Capacity Population
Design Current
C•attEe Capacity Population
❑ Wean to Finish ; ❑ Layer
❑ Dairy Cow
CS Wean to Feeder t, D D
1❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Gilts
El Boars
El Beef Feeder
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ Other JE1 Other
Number of Structures:
Discharges & 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 fZ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PINo
❑ NA
❑ NE .
❑ Yes
B No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

t
Facility Number: — Date of Inspection ti 1
i
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
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[9 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
BNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EgNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of-Accceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)C _��tJCyt:'r �f'�SG1� tic
13. Soil type(s) 4 !J�5 2C -A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R NNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [-]Yes [9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes O�No ❑ NA ❑ NE
Use drawrng of facility to better explain sihtaain any tians (use addettvnala ayes as �mQsda tions or a 13 v t =
p .., ,.P : ti ny er comments.
;. ... V
Phone-
Reviewer/Inspector Name f r?
Reviewer/Inspector Signature: Date: /
Page 2 of 3 12.128104 Continued

Facility Number: —Nk Date of Inspection �7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [6No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 4No . ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[5l•No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[LNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ 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
ERNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

ivision of Water Quality
Facility Number . 0 Division of Soil and Water Conservation
0 Other AgencyaD a
Type of Visit ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit //Z-V Arrival Time:/ 7.'�d Departure Time: County: � Region:/��0
Farm Name: Owner Email:
Owner Name:., gfzzaL-CAdHataa 6yrV4Phone:
Mailing Address:
Physical Address: /
Facility Contact: Vaya2l Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: v1.5; Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = L Longitude: = o = 1 "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
[❑ Wean to Finish
CK Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ei
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & 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?
Design ,Current
Cattle Capacity Population
❑ Dairy Cow
❑ DairySalf
❑ Dairy Heifer
❑ Dnr Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
'f
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?
-I
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
JRNo
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
12128104 Continued

Facility Number: - Date of Inspection - T
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):
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 2TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,K1 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes „& No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IgNo ❑ 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 fallo ❑ NA ❑ NE
maintenance or improvement?
Waste Anylication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �.Y 1q-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes f gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ERNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
®.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):
L
er/inspector Nance Phone:er/Inspector Signature: Date:
12128104 Continued

t
! Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [21No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;.No ❑ NA ❑ NE
the appropiate box. ❑ ATUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J.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
FSNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EffNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Wo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B 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
Z 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?
El Yes
(� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

015`ivision of Water Quality �- J
Facility Number 0 Division of Soil and Water Conservation 3— 40-,UV-
_ 0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Mine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
A
r
ri
val Time: c�i)0 [i Departure Time: County: Region:
Farm Name: -, -_n n �YT _ T G-cxG� Owner Email:
Owner Name: wi� ( InN a,- t7 L_ (!4=2-pD „g*� Phone:
Mailing Address:
Physical Address:
Facility Contact: V{Wi/ (' dpi.— Title:
Onsite Representative: Jr M.i---
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:/^S/ate
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 4 Longitude: 0 ° = l = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�O 1 ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
[7Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
!Number of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
§a No
❑ NA
❑ NE
12128104 Continued

' I
"
Facility Number: — Date of Inspection r3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ERNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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 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
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below.
❑ Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) , gvw�l e
13. Soil type(s) & 1,45 k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vu No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V;LNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
OLNo
❑ NA ❑ NE
Comments (refer to question #) Explain. any YES answers and/or any rLeco�m i tndations or iny.other comments
Use drawings of facility to better explain situations. (use additional pages�as� necessary);
Reviewer/inspector Name I Phone:
Reviewerfinspector Signature: Date: %� d
P.,00 7 of 2 17/7x/lla 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 CAWMP readily available? If yes, check ❑ Yes [Z 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 ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3 No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[K No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R 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
Z 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
Q 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
F] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D�LNo
❑ NA
❑ NE
w, fi AY
Additional .Gammenfs andlor Drawings:
i
Page 3 of 3 12128104

Type of Visit a-diompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a ' Arrival Time: Departure Time: VaIt 3 0 1 County: kr1't- Region: f:z'i�7y
Farm Name: L! d e // PLa C Owner Email:
Owner Name: C�Q r2H f �� ���i°Phone:
Mailing Address:
Physical Address: /
Facility Contact: V-C_1.�z; Title:
Onsite Representative: 54X2�
Certified Operator: 7 �r
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [--] o E:] ' 0 « Longitude: = ° [=]' = u
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
;3-1wean to Feeder ORO
❑ Non-Layet
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑Non -Da'
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Pouets
❑ Other EEE
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
BNo
❑ 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
10 No
❑ NA
❑ NE
other than from a discharge?
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
EE�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ERNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
kg -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
JKNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IN No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q Z pp/' 4e:.a/ /eenSr!i'ue
13. Soil type(s) _& -h A -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes f KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to betted explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: /59 / D]
iG/Lo/u4 a.unurFura

" Facility Number: Date of Inspection — 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �gNo ❑ 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 JgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V1 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E8 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[ ] YeS
J9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IN No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ 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
,SNo
❑ NA
❑ NE
Comments and/or Drawings:
12/2R/04

Type of Visit 9-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "p L Arrival Time: Departure Time: '� County:
Farm Name: eAVIZ
/ & en -Owner Email:
Owner Name: ; c't +- dot �'t- �7f?a�c w Phone: _
Mailing Address:
Physical Address:
Facility Contact: tV_&Zg& Of 8-0 00l1-1— Title: Phone No:
Onsite Representative: Integrator: 42252�
Certified Operator: ,y�'''�� �_ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region: D
Latitude: =1 o =1 = Longitude: ❑ ° = ❑ L
Swine
Design
Capacity
Current
Population
Wet Poultry
Design Current Design Current
Capacity Population Cattle Capacity Population
❑ DairyCow
El Dairy Calf
❑ Feeder to Finish
DairyHeifer
❑ Farrow to Wean
Dry Poultry
,` ;;
�"
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
Layers ers
❑ Beef Stocker
❑ Gilts
Non-❑ ers
❑
❑ Beef Feeder
❑ Boars
Pullets
❑ Pullets
❑ Beef Brood Cowl
--
❑Turke s
Other
❑Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges
❑ Wean to Finish
❑ La er
Wean to Feeder
�aB
10Non-La Non -Layer
&Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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?
Page l of 3
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
JK No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
& No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
JX No
❑ NA
❑ NE
I2/28/44 Continued

t Facility Number: 9,— Date of Inspection
.1
•r
fr Waste Collection & Treatment
c —
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
L,No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E4 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
N 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 C&No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9LNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) G a , Z Zy. �r rr rs ,e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes JS No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes C.No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RNo ❑ NA ❑ NE
..Comments. (refer to gge4i6n #I): -Explain any YES answers and/or,"9,iri commendations. or any other comments. .
Use dwin s.offacdbetterexplain situations. use addtttonal ? g es as necessary): t'
r,,•r r�
Reviewer/inspector Name �~ — rrhC
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 12128104 Continued

Facility Number: — Date of Inspection
1i
r Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ?Wo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
24No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[B-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
04 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R 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
2�.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
DANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerhnspector 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
XLNo
❑ NA
❑ NE
Additional Comments and/or Drawings: ..
Page 3 of 3 12128104

Type of Visit (compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: n�
��/�- Arrival Time: � Departure Time: t p County: r� Region:
T.L Farm Name:
3� —, A__'f't &e- '-_ Owner Email:
Owner Name: 4 Do j, rd(!�:C��' l� LTQD�� � Phone: Qom/ 0 ^ l�—�/� 9
Mailing Address: r�i tJ i'i-t" CSDm�I:•H , Rd 'A -
Physical Address: _ SZ: j_;20, ''
Facility Contact: .___ _S'aow -r— Title: 0 UU n Lr e— Phone No: S'Z-w -e
Onsite Representative: S' Integrator: &21_=�, 4=aI`irrS
Certified Operator: ` rn- _ _ Operator Certification Number: 14Z19
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = 0 « Longitude: = ° = 6 [� «
Design Current
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder Q 000
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars '
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ La yer
❑ Non -Laves
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Disebarp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Da Cow
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes Q9No El NA ❑NE
❑ Yes
5d No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
171 UNNo
❑ Yes
® No
❑ NA
❑ NE
❑Yes MNo El NA ❑NE
12128104 Continued

-ti' w
IFacility Number: 6)g—/ Date of Inspection f-D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rM No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ../ Q-
Observed Freeboard (in): _ 92
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
INNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there, structures on -site which are not properly addressed and/or managed
❑ Yes
CgNo
❑ 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?
El Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WN No
❑ NA [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
K 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
XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) S-,:rTtn VJA!A— & Ca.W Z:: Z 0,5 C u
f a -Z
_
13. Soil type(s) - Z �5,K A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CgNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
Ci�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment'?
❑ Yes
ER No
❑ NA ❑ NE
Reviewer/inspector Name k Y �,.�. Phone: _/f—IS�%I 3
Reviewer/Inspector Signature: Date: /q —
IL/LP/V`f a. ...I.-

Facility Number: Q — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes K 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
P(No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CKNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E,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
D9 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
tR 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
E@ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Addttiostal Cominents•and/or Drawings
3 �117
12128104

Type of Visit v Compliance 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: d I LY rune: LCl7
— — O Not rational O Below Threshold
Permitted ,M Certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Pt_.. County: e-�.�__.Farm Name: ... .
Owner Name: �r� ,.�_ _. Phone No: !f? (a i(r ` yY qS
Mailing Address: R5`Ib9447f 64eA.+{ �Ti?Ri7e��outL
Facility Contact: . _ . ! 0,T (�2004g&_— Title:
Onsite Representative: fly; Q. eU
Certified Operator. _ "4 -------------- !& QQ.�--,
Location of Farm:
Phone No:
Integrator:..
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a " Longitude •
Disehames & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes S No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge'is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaYrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [INo
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 EdNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
(
Freeboard (inches): y
12112103 Continued

Facility Number: g b Date of Inspection ll ZY D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes %No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes J,No
closure plan?
(If any of questions 4-6 was answered Yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes JffNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 29 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [13 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 59Vo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Coo-', J Re-crnUdIaL 4 m Z��e_ — OV't—Se *1 4 ra v Q _ _r_..trure__ It -a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Wo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes KNo
b) Does the facility need a wettable acre determination? ❑ Yes RNo
c) This facility is pended for a wettable acre determination? ❑ Yes �5No
15. Does the receiving crop need improvement? ❑ Yes MNo
16. Is there a lack of adequate waste application equipment? ❑ Yes KNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ANo
Air Quality representative immediately.
Field Copy ❑ Final Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: I 1 Q It
12/12103 / Continued

Facility Number: Date of Inspection
Re aired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes PkNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUFr, checklistrdesit< map etc.) ❑ Yes M(No
23. Does record keeping need improvement? if yes, check the opriate box below. []YesRNo
[I Waste ApplicatickK ElFreebowe ❑ Waste Analys Soil Samplingpol-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ANo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
§LNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
0,No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
K10
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
allo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34_ Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking For❑ Crop Yield Form ❑ Rainfalls❑ Inspection After 1"
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

R.
LO Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
-. — 7
Facility Number Date of Inspection /
Time of Inspection �Ob 24 br. (hh:mm)
Total Time (in fraction of bourn
Farm. Status: ❑ Registered ❑ Applied for Permit (ex:1,25 for I hr 15 min)) Spent on Review
Q Certified ❑ Permitted I or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:
Farm Name: County: _�� � ......� .... - _..._.
Land Owner Name:.!... >F� �rztlr?.!_J.............. Phone No:��L.�I.3.
FacHity Conetact:. °" Title: Phone No• ..
Mailing Address:
Onsite Representative:.. R%' '�i✓. _ ... _ . _ ........_. Integrator:.._
Certified Operator:... _ ..,f�lfL.^�. .. / ....... .. _..... .., Operator Certification Number: %` z..... .
Location of Farm: ;rRp....• s✓�./ ��,€��_ ��-!�j/-T7j >Q17��
Latitude •6 " Longitude 4 4,
Type of Operation and Design Capacity
. � Design Current a „ DesignDeslgn� Current«w
Srv�oe _ >� Cattle Ca t aci Po ulat�ou C ac! .. Po ulatxon rPouitr3' Ca~ acttvM¢Po tllatlonk
,
Wean to Feeder �O Layer❑ Dairy
— - � : j
Feeder to Finish Non -Layer Q Non -Dairy I
Farrow to Wean j Mg
''l.`#:?', ^ x'"yl, r ash 't"�
s4 k
Farrow to Feeder Totat�Destgn Capacity w�
<q
Farrow to Finish
Other <��»
Number of'Lagoonsr/ I3oldiisgP s / Subsurface Drains Present`
»%
N- w ❑Lagoon Area ❑ Spray Field Area
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: Q Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 0 No
❑ Yes kNo
❑ Yes h�No
❑ Yes XNo
❑ Yes
XNo
❑ Yes
XNo
❑ Yes
f No
❑ Yes
�No
Continued
on back

Futility Number: ... I
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4 No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
O-NO
9
ct s as ons and/or Holding. nd
9_
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
4No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
Wo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
fVrNo
12_
Do any of the structures need maintenance/improvement?
Yes
❑ No
(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 Iack adequate minimum or maximum liquid level markers?
❑ Yes
UNo
31'aste Unlication
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement? ❑ Yes .® No
19. Is there a lack of available waste application equipment? �� No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
For Certified Facilities nl
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ANo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
24. Does record keeping need improvement? ❑ Yes U�No
Comments /(refer t0 quesUpn #I)Eicplam ariy YES �answeis andloir any recommetidahans'ar any other comments k R
Use drawrngs of facilityto lie `< p ( x p g <'sarY) `' y tter ex lain sttuat►ons use addtttanal a es as necesM fti k
/Z.S /S �N,�iJ,¢.�.✓v�i4�� /�� s3trcrGa�.�� -��/ 4
17i % ,fh G€.,.o,c�.� y.t'Ok� ��'C�.rr.`�.✓��o..,:q /.z� /�`� �.G�.�/../�,�r/�!/.F�.9-r,�E
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: g— / 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97