780022_INSPECTIONS_20171231

r; I)lvisian iif Water Resources
z Facility Number � - �—� � Division of Soil and Wa#er Conservation
I Clther Agency
Type of Visit: CF Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'x3 Departure Time: f County:
Farm Name: Owner Email:
Owner Name: Y4Af /x /1L Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
Onsite Representative: 5���� Integrator:
Certified Operator: , J ""
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
i'
Design
Current
Design . Cnrrent
Design Current
Swine
Capacity
Pvp
,Wet Poultry Capacity :Pop.
CattleMC-apacity Pop.
Wean to Finish
' Layer
Dairy Cow
Wean to Feeder
iN;. Non -La er I
Dairy Calf
Feeder to Finish
% is
��p+�
',' !' !Ic' l "' I
Dairy Heifer
p.Design Current
Farrow to Wean
Dry Cow
Farrow to Feeder
A. D' , Pou It C aci f',o .
Non -Dairy
Farrow to Finish
q Layers
ker;M' Beef Stoc
Gilts'
_' Non -Lavers
Beef Feeder
Boars
Pullets
113eefl3roodCow
Turkeys
Other
1 Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[] N
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IS"'o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: g-- �r Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ]Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �/ J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑' o
[] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a-lgo
❑ 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
Er —No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 o ❑ NA
❑ 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 1❑ Application Outside of Approved Area
12. Crop Type(s): 'J;j-/''fru / �t�r .rr�i�rJ �-��n ��✓/ rs / u?3,— v
13. Soil Type(s) f/J� i c,a� �1��✓�%/ 1 __. �� -�
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes '
❑"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3Io
❑ NA
❑ NE
Required Records_ & Documents
�-�,.�
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�J o
0 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. C Yes []r<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �lo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L' No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

.[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
I_ -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
Io
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[i] N
❑ 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?
%�'C> I ` `i a�-�✓ /r'�..� �fr✓ �.1�i1'� �' /mil r--G{ j C_ �r�✓ rG�l�
Reviewer/Inspector Name:
Reviewer/Inspector Si&mature:
Page 3 of 3
❑ Yes E o ❑ NA ❑ NE
❑ Yes ]o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
N
g
❑ NA
❑ NE
❑ Yes
'moo
❑ NA
❑ NE
Phone:jf7 ��--/�•�
Date: �y
21412015

I
Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �! 7 Arrival Time: / Departure Time: !7 County: /�Q��-y Region;j�—_�
Farm Name: _ %nf}'%� �a✓� Owner Email:
Owner Name: (I �f�-�G ��� ^� Phone:
Mailing Address:
Physical Address:
Facility Contact:�•zo✓X�,v� _ Title: Phone:
Onsite Representative: integrator:
r��
Certified Operator: Jam-- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
t
I ILayer
Non -La er
1) . P,oul
I
I
Design
Ca aci
Current
P.o -
Dairy Cow
Wean to Feeder
Feeder to Finish p
Da' Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Beef Feeder
Gilts
Non -Layers
_ Boars
Qther
Pullets
Turke s
Turkey Pouets
Beef Brood Cow
Other
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 2No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes gLNo
❑ Yes [B-No
❑ NA ❑ NE
❑NA ❑NE
[]NA ❑NE
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZLNo ❑ 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
No
[a 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
RNo
❑ 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
® No
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
® No
❑ NA
❑ NE
maintenance or improvement?
I l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
JZ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): a
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ [ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
© No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RA No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? (:]Yes ®-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®. No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
® No
❑ NA
❑ NE
If yes, contact a regional AinQuality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IQ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA
❑ NE
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

(Type of Visit: Eycompli ce Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — 6 / fi Arrival Time: _ % .3p Departure Time: _, 0 County: ti �s �— Region:�
Farm Name: LN
Owner Name: 111L
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ��( 7-A a. o7-_ Title: Phone:
Onsite Representative: Integrator:�t
Certified Operator: �`� Certification Number: 7 Zv ,_�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
C►si#ie Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
11
iNon-Layer
I
Dairy Calf
Feeder to Finish
a
"' "' (
Dairy Heifer
Farrow to Wean
Design
Current
Da Cow
Farrow to Feeder
D , Poult .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 5No ❑ NA ❑ NE
❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
0 NE
Page I of 3
21412014 Continued

Facili Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rANo ❑ 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 [!�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 J3,No
❑ NA ❑ NE
waste management or closure plats?
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 qNo
❑ NA ❑ NE
8. Do any of the structures tack 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 sRNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes allo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes JEJ.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 ❑ Application Outside of Approved Area
/Wind/Drift
12. Crop Type(s): X e•lnt' y-G.-, 1-r'ot % corn
� A
13. Soil Type(s): G(Ja� rd.Y� �%L �FJ %! /Ll�l�r L•��I
14. Do the receiving croFs differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[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
M 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
[2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
allo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

• Facill Number: - Date of inspection: r-/6 �p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes K, 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 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?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes I�No ❑ NA ❑ NE
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
❑ Yes
J�g_No
❑ NA
❑ NE
Comments (refer to.question, ) Explain any YES answers,and/or any addttlonalSrecommendations or any, otlier2comn ts.
better eiplain
Use drawings of facility to sitnitionsjuse additional =as necessary): > -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/�33oa
Date:
21412014

4
Type of Visit: ommp�pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: elroutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; / Departure Time: O County: Region: F-9 0
Farm Name: 5ar "
Owner Name: w j--, zZe -vna— - - - -
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: S Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Desigp Current
Swine Capacity Pop. Wet Panitry
Design Current
Capacity Pop, Cattle
Design Current
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
a
Dr P,oul
Dairy Heifer
Design @urrent Dry Cow
Ca acit P.o Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Beef Stocker
K Beef Feeder
Gilts
—.Layers
Non -Layers
Boars
""
Pullets
9 113eef Brood Cow
Other
Turkeys
Turke Poults
Other
Other
Discharses 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?
❑ Yes L&No ❑ NA ❑ NE
❑ 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
C&No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
a 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pj_No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): . 13 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fo 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 Cg 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 E0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes U&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cg-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): / CDen /kVA,2%7//
13. Soil Type(s):
14. Do the receiving crops tffer from those designated in the CAWMP?
❑ Yes
5INo
❑ 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
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
V[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
IS -No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: jDate of Inspection: Zl-
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
[3j No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
fSNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
®No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3l . 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 CA WMP?
33. Did the Reviewer[I spector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes DqNo ❑ NA ❑ NE
❑ Yes C5].No
[—]Yes ® No
[:]Yes P!.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain anyYES answers and/or any additional recommendations or any other commentsram
-- ^ °-
t = a ~,
Use drawings of,facility to better explain situations`(use additional pages as necessary). ' _
P07r: U5r� /��v:5y-o>/ �D��GG�✓�-��/ire
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1/��
Date: �`�� �•s
21412011

[ vet 5 Wa.:7 I L(
Type of Visit: B'Com liance Inspection O Operation Review () Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: T I Arrival Time: Departure Time: County: P.,ebr4'.—Region
Farm Name: �/��f"�' Owner Email:
Owner Name: iq k(A— G I �� (� Phone:
Mailing Address:
Physical Address:
Facility Contact:J<L':Uqrp Title: Phone:
Onsite Representative: Integrator:
Certified Operator: i Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignCurrent
D ign Current
Design Current
Swine
pacity.-Fop.
WetlPau
city Fop.
Wean to Finish
Layer
Dai Caw
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
=-
Dai Heifer
Farrow to Wean
"Desigq"* Current
Dry Cow
Farrow to Feeder
i)" 1P,oultry
,rCa 'aci ••.; Po ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Turkeys.
Beef Feeder
FIBeef Brood Cow
Other
Other
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EE,� ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
B2,�� ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[;J-� ❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MA-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ID NA ❑ NE
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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes 1E],1da ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Aoplication
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): 4 6?,rA4 .�
13. Soil Type(s): Wr,, OA c(—^ o d , L. (edGri�.�
14. Do the receiving crops differ from those designated in the CAWMP?l
❑ Yes
J ` o
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EE] 1%
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E '7"
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P31�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [D'qo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
[:)Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
El Sludge Survey
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectioa�'
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

iFaeTkty Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [N�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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes eNo ❑ 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 NA ❑ NE
and report mortality rates that were higher than normal? V
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ Yes [ZLN6 ❑ NA ❑ NE
❑ Yes ❑'&o ❑ NA ❑ NE
[::]Yes E3 No ❑ NA ❑ NE
❑ Yes �No
❑ Yes L�No
❑ dl Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
ReviewerAnspector Signature:
Page 3 of 3

0

Type of Visit: .Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ""tine O Complaint O Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: ) Region
Farm Name: Owner Email:
Owner Name: _Z­AiiN_ VA r,01, tA_ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
tk4' kf YYI OAi S AtfiE:
Certified Operator: q
Back-up Operator:
Location of Farm:
Latitude:
R�t:-K, Phone:
Integrator: r l 1
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design ,Current «x, N Design Current ' Design
@specify Pop �WetP,o`ultry Capacity Cattle Capacity
Layer c Dai Cow
Garreat
Pap.
Wean to Feeder
�]Non-Layer
Dairy Calf
Feeder to Finish
Farrow to WeanDry
Farrow to Feeder
s
DPotut .. Ca aci P,o _ '''.
Dairy Heifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
r Non -La ers
y Pullets
Turkeys
Beef Feeder
Beef Brood Cow
=
Qther
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:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Egi- o ❑ NA ❑ NE
[—]Yes [:]No []�NA ❑ NE
❑ Yes [D No E] f< ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes [] No [�fA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E:fNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ff No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r •
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Zto ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [j j l o ❑ 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 [LjNo ❑ 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 [E 1<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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O.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
[]'110
❑ 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
[ 4fo
❑ 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
e❑
12. Crop Type(s): Cj J
13_ Soil Type(s): zc ,
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
❑ No
[!3-IqA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
[jjNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
2 A
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
P�TNA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
[DXA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
Q A
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
Q,XA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
MkNA ❑ NE
[.Heather Code
❑ Sludge Survey
Q44A ❑ NE
VNA ❑ NE
Page 2 of 3 21412011 Continued

.
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate wastc application equipment as required by the permit? ❑ Yes [�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 JN6 ❑ NA ❑ NE
Voe
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[P.Xo
❑ 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
Vo
❑ 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
[Vo
❑ 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
o
❑ NA
❑ NE
❑ 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
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
U/No
❑ NA
❑ NE
Reviewer/inspector Name:
PhonR0­V%1JJ 533
Reviewer/Inspector Signature:
Page 3 of 3

1�?
(Type of Visit: e'Cliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: klRoutine O Complaint O Follow-up O Referral Q Emergency O Other_ Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: 42v.>2. Region:
t
Farm Name: Owner Email:
Owner Name: Phone:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representa
Certified Operator
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: M-^.6
Certification Number: / 7!�!�
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
)Vet Poultry
Capacity
Pop.
Cattle Capacity op.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
DrtPo.ult,
Ca achy
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
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?
0 Yes Io [DNA ❑ NE
[:]Yes [—]No B VA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
IA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Qlo
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412011 Continued

Type of Visit: Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 3 Arrival Time: Departure Time: C1 A County: Ttp p/lJ
Farm Name: Owner Email:
Owner Name: }1n i�_ rnr j_fA/ll Phone:
Mailing Address:
Physical Address:
Facility Contact: �pt�C��[en.DrScsf� Title:
Onsite Representative: ickrim!j —r%-"0 ,a h
Certified Operator: 7 IlnmDs6"
Back-up Operator:
Region: rRo
Phone: %t0- 3t2-14?(
pp
Integrator: � t fR p by B'en wN
Certification Number: 17 41q57
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design urrent mapsign Current
Capacity Pop. Vet Poultry acityCattle
Layer
Design
Csapacity
iry Cow
Current
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -La er I
-04b LAQn
Design CulTent
D,ry P■ault • Ca xei Plo
La ers
i Calf
i Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other —.Turkey
Other
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Fie❑ 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 GjNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes [:]No
[:]Yes ❑"No
❑ Yes [(No
EJ NA
❑ NE
[DNA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
gNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0' NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: -0.7
Spillway?:
Designed Freeboard (in): IT
Observed Freeboard (in): a 9
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
ff 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
L] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
B 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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 j -c❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types}: IRr� uG��N J 6 I6 ,C4,eA* 1�•r of
13. Soil Type(s): LIA5le� jjj&[A40, LI'Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] No ❑ NA ❑ NE
acres determination?
17. 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
Ej No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need. improvement? If yes, check the appropriate box below. ❑ Yes [E�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 Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 21412011 Continued

1 r
Facili ° Number: i - Date of Inspection- 13&311 14-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []'No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [Er 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 provide documentation of an actively certified operator in charge? ❑ Yes CyNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej 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 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?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes E/f No ❑ NA ❑ NE
❑ Yes [j No ❑ NA ❑ NE
❑ Yes E� No
❑ Yes 9 No
❑ Yes ETNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # :Explain any YES ansRers:and/or an addition al,recotnmendatuon�s�o any otii r combients.
3
Use drawings of lac�ltty to better ex lain situations use=add�itonaL a es. as necessa
fielm ti.eoKCD CAD.
R 4c-oR ©5 Au��1� >✓ s ►a a� fl>`Q
Reviewer/Inspector Name: ,/pFk p), 9�\_Mrn_QS Phone:
Reviewer/Inspector Signature: Date:
Pare 3 of 3 21412011

Go* 06-
Facility'NTumbcr: - Date of Ins eetion:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3'�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &TH ❑ NE
Strut e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): lAq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes K 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 ET to ❑ 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 E3N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�r<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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �To ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13_ Soil Type(s):
14_ Do the receiving crops
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
❑ Yes
�J No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes E]4 ❑ NA ❑ NE
❑ Yes Rio ❑ 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
53 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes. check the appropriate box below.
les
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Sail 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
E3 110
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[—]No
CIA
❑ NE
Page 2 of 3 21412011 Continued

F cili ' Number: FZY jDate of Inspection: 77
24. Did the facility fail to calibrate waste application equipment as required by the perm( ❑Yes �To ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ga qo— ❑ 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 E o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ®'�
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �lo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
[—]Yes Io ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes f//o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gg-Na ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes a j Ko ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3

Al/til-S G/Z/ /Z o/o
Type of Visit Q'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ty ttoutine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S-D(, -/Q Arrival Time: Departure Time: 2: O p County: Ro to eson/
r
Farm Name: J r �d t __ Owner Email:
Owner Name: 30 ci Phone:
Mailing Address:
Region:
Physical Address: 1
Facility Contact: RQwct cj `` / �7no4p50,W Title: i s u/ �� 'lI leYPlrone No:
Onsite Representative: G!N a D Al Integrator: NUY2 'gam `d n1
Certified Operator: n= Operator Certification Number: f ;rea 7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = & = u Longitude: ❑ ° = I ❑ u
Design Current
Design Current
Design Current
Swine oapacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -La er
I
❑ Dairy Calf
Z Feeder to Finish 1-7040
f
❑ Daia Heifer
❑ Farrow to Wean
Dry poultry
El Layers
❑ Dry Cow
ElNon-Dai
El Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other I
❑Turke Poults
IEJ Other
Number of Structures:
Dischar¢es & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
NA
a. Was the conveyance man-made?
❑ Yes
❑ No
e
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
ETNA
❑ 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
Ua<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L7No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

9
a
Facility Number: %g — 2Z
Date of Inspection S-Oda-/a
Waste Collection & Treatment
INA
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 ❑ 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
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
7 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 thr t, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
N El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
IJ 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
E' No ❑ NA FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E7 No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
3Flo ❑ 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 Qutsi4e of Area
12. Croptype(s) GSCJ�Iud�t_ ! fT6N ) .
13. Soil type(s) 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[INo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�7<9 ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesEl
NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
V ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No El NA
❑ NE
Comments (refer to Yon,#)•✓xplaianyYESnn.recommmmennest�oyhts
se.drawings of facility to better explain situations. (use additional "pages as necessary): ? , h
Reviewer/Inspector Name F�! .. R eS Phone: 9i0. *33. 330a
Reviewer/Inspector Signature:Date: J�-D6 — ZO 1i7

Y
• Facility Number: 7g —Z2 Date of Inspection
Re aired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N ❑ 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 El Other
21.
Does record keeping need improvement? If es, check the appropriate box below.
p g P Y
❑ 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 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E 4b,ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
wWbo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
❑ NE
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
Zo27.
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,_,%No
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
U 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
2 N
[I 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
N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
LfJ No
❑ NA
❑ NE
Page 3 of 3 12128104

Is
Divlsion of Water Quality
Facility Number 7 Z 2 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,-ommpliance
(71toutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Departure Time: County: 90beSOA/
Farm Name: M f r Owner Email:
d
Owner Name: Svi� a /K �l s• ../ k nN f t� c a n! Phone:
Mailing Address:
Region: ��2U
Physical Address: p /
Facility Contact: AQAlau �6Jt o r •.-nr .SG' n/ Title: AA1 &1 — Phone No:
Onsite Representative: ea A. d,21f7"Alcapen/ _ _ Integrator: ✓ �1'L74�N
Certified Operator: _ u N 4CL q Th e•'1DSG -1/ _ Operator Certification Number: /!% 457
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 [ = = Longitude: 0 o = ' = 11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
10 Wean to Finish f
❑ Wean to Feeder
eederto Finish O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
DesignY,Current; .
Capacity Population
il
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U(No ❑ NA ❑ NE
❑ Yes ❑ No E NA
❑ NE
❑ Yes ❑ No 93"NA
❑ NE
❑ Yes ❑ No L7 NA
❑ NE
❑ Yes 3No ❑ NA
❑ NE
ElYes ❑ No [ENA
❑ NE
12128104 Continued

y
Facility Number. `] 9 — 2 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,�
L"J No
❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
❑ No
,.❑_, �NSA
B NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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
E 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
[3 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
,�,/
IJ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1_rt"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 r
12_ Crop type(s) Se- -m ,L<L , (8,11 � 5rviaq Ge&(Gyerstr.d,) Cow-N 1.�i �&L4- Se i Le4N lrG4aitw)
ff
13. Soiltype(s) jdajl�z,,.+, 1AtCeir-ctiGela�►C1 I�+a�`f'�1k i�ct�nrs
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ErNo ❑ NA ElNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EI No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes Ltd 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 [3 No ❑ NA ❑ NE
'a�Camments {refer tosquesttan€#)Eiplaen ariy.YE3_answers andlarasy recammendrattoother commentUse draRREgiwtn of fade tobetterex lam sttuahons:- use a ldrtEonal€, ages as necesl' -J pT { P N
�....,:c.�.-.. IN
r
•
Reviewer/Inspector Name I1 " •Kv Phone: 9/0. *33 .333 q
Reviewer/Inspector Signature: Re-IC-4— Date: 2 3 --2009
Page 2 of 3 - 12128104 Gonfinued

Facility Number: % S — Z2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MINo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
E?Io
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
ETNo
❑ 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
Oo❑,
NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No
DIVA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,❑,,
B, N' o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,LYNo
U3 No
NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
,❑,�
L'"I NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L7 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
ErNo
❑ 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?
El Yes
0'N* o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

ST114 s s//oz/d 8
ivision of Water Quality
Facility Number 2 z 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit @*'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 02 'fir' O $ Arrival Time: //.� 53 Departure Time: County: z0Q6e5'0'W Region: �120
Farm Name: / Lal.tavf Owner Email:
Owner Name: 14. $1 c./crr/ Phone:
Mailing Address:
Physical Address:
Facility Contact: V elnnaL cc.,._t Title: 6 w N 4'v— Phone No:
Onsite Representative: Integrator: /Clue h'r2rrj ✓
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: 0 0 = , 0 u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I I :::::]
❑Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes T No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[ffNo
❑ Yes
I� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

` Facility Number: ']S- Z Z Date of Inspection OZ-// OS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes [)4No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes [A No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: ,p
Designed Freeboard (in):
Observed Freeboard (in): �t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 R 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 (A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [,No ❑ NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El 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 indow ❑ Evidence of Wind Drifl ❑ Application Outside of Area
8cv.�ru 0.
12_ Crop type(s) �� r -Z r S 4e.11 Me /17/rb-/ J [dVs► a�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
(0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[n No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/inspector Name P11 c-Phone: 910. 4-� • 33oa
Reviewer/inspector Signature: e,—,_� Date: 02 - //- ZOd p,
12128104 Continued

Facility Number: 7 g — Z Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiiate box.
❑ WUP El Checklists ❑Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EdNo ❑ 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�B No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�RNo
❑ 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
P3No
❑ 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
M No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
)A No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r
t BI HS 411016-1 u Vf
® Division of Water Quality _
Facility Number z z 0 Division of Soil and Water Conservation
- — 0 Other Agency
Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 2 �'O Arrival Time: 0; O Departure Time: //. 3.JA,,, I County: RobLe50w Region: F�
I
Farm Name: M E 7— rakeu Owner Email:
Owner Name: T:, V- h C j e_a Phone: /U Z O y g�
Mailing Address:
Physical Address: nn ll �/ /
Facility Contact:® ItaNlJ 4 llf7TQ�! Title: I4NGCGY Phone No: {?%/a) g�il� b�Z9
Onsite Representative: Integrator: 1�u�.a�� /Qrauhl
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = u Longitude: 0 ° =' = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
1 10 Non_La_et
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
El Turkey Poults
to Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
:;ODeSign :.' Current; r=
CaPitity'I. Population?
❑ Dai Cow
El Dai Calf
❑ Dairy Heifer
❑ pry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
`i
❑ Yes MI No ❑ NA ❑ NE
❑ Yes
CO No
❑ NA
❑ NE
❑ Yes
[;9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
, Ii No
[DNA
❑ NE
❑ Yes
;] No
❑ NA
❑ NE
12128104 Continued

t
Facility Number:`y — ZZ Date of Inspection y-27-a7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
ElYes
Lp No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[)f 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
[f 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
EM 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
[)9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[7No
❑ NA ❑ NE
maintenance/improvement'?
l l _ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ of Wind Drift ❑ Application Outside
of Area
/Evidence
1
12. Crop types) �tlrwt k did ya,� 1 %i.e�7' rw �Ae ,.✓Lf a tns5�.,�q(
13_ Soil type(s) Wtj rn », Hr,cotl Lovpla,
i
14. Do the receiving crops differ from those designated in the CA W MP?
❑ Yes
[y No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[j9No
❑ 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
[)9 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):
G&0d. far � t.
Reviewer/inspector Name /,,-- L k,, ee.✓t Is Phone: (9/0) µ33- 333 0
Reviewer/Inspector Signature: Date: 3 -27 - 2 oD %
12128104 Continued

4
Facility Number: '1$ —2 Z Date of Inspection 3-270 7
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CM No ❑ NA ❑ NE
the appropiiate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N 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
El No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QFNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

a
® Division of Water Quality
Facility Number `] O Division of Soil and Water Conservation
- " - is. other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time, Departure Time: County: 9Dbe SO,ti1 Region: __.
qQ
Farm Name: _ _� �'�`�I Owner Email:
Owner Name: M d @C, tit Phone:
Mailing Address: _ _—
Physical Address: d e4 s4, ! ! 11L! V _ C_ Z Y-3C 4/
r� � � — ��_. J S � KCI COX - /�- --
Facility Contact: izokw dm A i,--A Sep n1 Title: Q!}L✓zJX-_ Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o = ' E Longitude: = ° =, =
Design' "Current Desrgn Current¢ Design FrentiIIIIIIII
Swine Capacity Pop la[ton: �V.et Poultry CapacityPopulatron t battle Capacity Population
❑ Wean to Finish ❑ Layer ' ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -La et I
❑ Dairy Calf
EN Feeder to Finish 7 04n A 5V A -P ❑ Dairy Heifer
❑ Farrow to Wean -,Dry Paultrv� El D Cow
❑ Farrow to Feeder9 . ❑ Non -Dairy
❑Farrow to Finish ❑ La ers
❑ Beef Stocker
0 ❑EEO]
ilts ❑ Non -La ers
❑Pullets El Beef Feeder
oars ❑ Beef Brood Cowl❑ Turke sTurke Poultsher ❑Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
f -1 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (I f 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
1;9 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 7— Z Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JgNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / -clt r
,t
Observed Freeboard (in): Z 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[rNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
'
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[' No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
' �9 No
❑ NA ❑ N E
(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
[9No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Sg�4 L0c:,j,jS J 4t01 (dGqGN,w" wd CL kG,'
13. Soil type(s) W a 13 , Mc_ L a'S
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
[;R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name?f_r�� ' 2.r 2 s =T �� b" F a g . , Phone: (910) 'V�(a~/_S41
Reviewer/Inspector Signature: Date: - 3 1 - 200 (p
12128104 Continued

Facility Number: —Zz Date of Inspection 1 '31-Q (p
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes � No El NA El NE
the appropirate box. ElWUP El Checklists ElDesig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER 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
[ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IgNo
❑ 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
"�"4 No
❑ NA
❑ NE
2&
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
No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
99 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
1� 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
EwNo
❑ 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
[INo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ 4 No
❑ NA
❑ NE
orD.,ate
A ddttiii'naI Cointnents n'dlrawtiigs,
t
,y
12128104

Type of Visit Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O 1=ollow up O Emergency Notification O Other ❑ Denied Access
Facility Number ) Date of Visit: T-=e: ' 3 �
.. O Not Operational Q Below Threshold
�ermitted CI -Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _.
Farm Name: _ County: &g btstrt F.P t]
Owner Name: - 114 - -/ i ^cLra,�, _ Phone No: 171d - 5�.?/ — O YS /. .
?VlaiIing Address: _� `� e!! /f o.-, e _ az& NG 3$3
Facility Contact: ---- S� 4 o . OIL164- .. Title:
Phone No: `-/0- 8'4f !f - 6g.2 91
Onsite Representative: , c Integrator: �� _J • .Z
Certified Operator: N me /-fa, Operator Certification Number.
Location of Farm:
M4Wne ❑ Poultry ❑ Cattle ❑ Horse Latitude • u Longitude ' 0"
'A]
Swine [a
Desagn Curizi
. ... �[`anac�ty �:Peinnlati
o Feeder
Layer
to Finish
DKo
to Wean=`
=` :'
to Feeder
r
to Finish
_ Ti
Discbamm -Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made?
:'Cattle
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
1'A16
es
❑ Yes ❑-No
❑ Yes Mwo -
❑ Yes Q-Af5
❑ Yes ❑-WO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M. o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MWo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): Ly L/
12112f03 Continued

FAdHty Number: 7
Date of Inspection �D-ate •e
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0-96'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [J Yes �o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetmprovement? ❑ Yes 9-140
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes EINo
9. Do any stuctures lack adequate, gauged markers_ with required maximum and minimum liquid level ❑ Yes L-No
elevation markings?
Waste Api ication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes El -No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes EW6
❑ Excessive Pondingy ❑ PAN ❑ Hydraulics Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop We �.J�rn,u.�.rr�sc L✓l,�.�—. <ni,4"
13. Do the receiving crops differ with those designated in the Certif ed Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
IS. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Arc there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
Nr. %%G�P/ry1 US T41 iIFU u. r 1"Li /C pbP�(,� rrc- Cac-., �Y
Reviewer/Inspector Name
❑ Yes Owo`-
❑ Yes ❑ No
❑ Yes [:)No
❑ Yes ❑ No
❑ Yes QWo
❑ Yes MNo
❑ Yes ❑ No
❑ Yes Mlo
❑ Yes �o
❑ Yes C3'No-
M-Field Copy ❑ Final Notes
,t ks t s>le
Reviewer/Iaspector Signature:
�cilwva
Date: off_
Continued

Facility Number. Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 01 KO
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑Yes
(,a.#6
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Oo
❑WasftAWUCfttitU ❑ Freeboard- ❑ Waste Analysis ❑.Se4Sampliyig
30 7 -�,2 '-/- fin ? 3 •Q ,7 -.�3 � 7, n_ I U-. �.
24. Is acility not in compliance with any applicable setback criteria m effect at the time of design?
❑ Yes
—_�
�o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-W
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
to
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes
EWO
29. Were any additional r oblems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑NO
NIMES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, slip questions 31-35)
0-Y-e-s
❑ No
31. If selected, did the facility fail to install and maintain raitnbreakers on irrigation equipment?
❑ Yes
❑-No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑m-
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
O-No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
l2/l2103

z
Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint Q Follow up ® Emergency Notification Q Other ❑ Denied Access
Facility- Num er _ Date of Visit: oh Time: S'
Not Operational 0 Below Threshold
[}'Permitted [3-Certiified O Conditionally Certified O Registered Date Last Operated or Above Threshold
Farm Dame: -- _pad % /urriS - County: so
Owner Name:
Mailing Address:
Facilit•- Contact: 7a4.. Ac /fr zVa!2 Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
svvine ❑Poultry El Cattle ❑Horse Latitude �� Longitude �• �• 0"
Design Current
Design Current Design Current
Swine Capacift Population
Poultry
Capacity Population Cattle Ca acit-, Po ulation
❑ Wean to Feeder
I
I
JE1 Laver
I
Dairy
❑ Feeder to Finish]
Non -Laver
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Bow
Total SSLW
Number of Lagoons ❑ Subsurface D
Holding Ponds 1 S6Ud Traps No Liquid W
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharze originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar-2e is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spiltwav
Structure I Structure ? Structure 3 Structure 4 Structure .i
Identifier:
Freeboard (inches): 3� ._
OSIV310I
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

.�
�
Facility Number::77��
Date of Inspection 9
yy,,,,)
5. Are there any Othreats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
iirifn6d'
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes
❑ 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
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste A RLhcation
10. Are there any buffers that need maintenancerimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
I6. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
JWG? 5]�aTf v�� P� FGPry GS ti
r�S4�T o�
;h f61.,,4y
rrO*n a
IOLVO 4er,al I fr9�i�
OVc'r ]`�►c �rrw, trrOvho� %0: 3V
c� Q'%%'6�/f
r fG FvreS
S4vt,'eol
G r/Ig.CF•'o� a�uh
AAe e,,,l /f; P�,/
Gr a� T'�a�*/Sar►
Net... narr44ol 6�%Jl�'rPci(OnJ��e •rrgal!`o� ins f�a7�
9
a��owe� frte 9v�tf 40 '/�'oG, �(c G.
as*� ku.Tt�- rq�7�liPr. W V``
J) ✓ / I- ` RS a
�hA NiYIS s�Oray 17 �D !<�C �r Pe 5 �c�? f oa IY.�� ti Yo i1w g rc:✓n or (-We, x4" Grr� ✓tea{
V _
Reviewer/Inspector NameC3, _ — 7 €. w
Reviewer/Inspector Signature: Date.
iw�Lrv� �.uruuaueu

.,
Facility Number: --.? 2 1 Date of Inspection
'7-8 K1��
Required Records & I3ocuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
26, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
28_ Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
29. We.. any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
NFDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I- Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit Routine t' Complaint O Follow up O Emergency Notification O Other El Denied Access
Date of Visit: lLL Time: // = Z S
Facility NumberrO Z-Z.
Not Operational 0 Below Threshold
0 Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: In £ T FAy-Iy]- County.
©caner Name: a o�%nr 4 • MC "1'j Phone No: ho) 52-t-04Tl o-r Q--iaDZq
Mailing Address: f 2-1d IV. i�l�ai jtrot � ROM I �, ZS 3 ( �
Facility Contact: �� A 4•4;' NOLA J9501—IJ Title: �C Phone No:
Onsite Representative:
Certified Operator: &ac &A ti � • T�o►kP Soul
Location of Farm:
Integrator:
Operator Certification Number:
bN •N[ ��e So G Sid.- 0-r 52- llbS p � • 3 �w°�eS So,6k o-Pi Ps anrkrsw �v
t rk) Y Sa 1 F"
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' ' Du Longitude • 06 0�
Design
Current Design Current Design Current
Swine Capacity
Population oultry Capacity Po ulatian Cattle Cavacitv Population
Wean to Feeder
El'
❑ Layer ❑ Da
Feeder to Finish1-7,D40
I Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Numberof Lagoons
OF ❑ Subsurface Drains Present ❑ La oon Area
_...__. -- .
❑ Spray Field Area
— - -
Holding Ponds 1Solid Traps
�li ❑ No Liquid Waste Management System
Dischar¢es &: Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Ficld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
30"
05103101
❑ Yes 1p o
❑ Yes L�/N
ElG/o
Yes ?9,0
❑ Yes //o
❑ Yes ,2 o
El Yes Lt.3'No
❑ Yes B<01
Structure 6
Continued

Facility Number: -7g — 2 Z Date of Inspection 'I•-•43
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes B
❑ Yes l_'TNo
❑ Yes aN/o
El Yes 914,0
❑ Yes B
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
1 I.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12,
Crop type �-. <. �r �X..S
T❑
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fait to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer tou ues#ton # E human AYES answers " e
) andlor an recommdahons,,or aDu.
Y Y- tber coruments:° .
IUse draw�ngszof facrltty to. betteyezplatn sj@Rions. (use addi-4onalpages as necessary). ❑ Field Copy ❑ Final Notes
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:
05103101 r Continued

V
Type of Visit K
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Z Z `0 Time:
10 Not Operational Q Belov: Threshold
Permitted © Certified 0 Co itionally Certified [3 Registered Date Last OperatMove ThresholdFarm Name: 1' �r County•pSei>-`
Owner Name: a O 4 -t- Le Phone No:
Mailing Address: /ACT WO/r't k-- �lc. _��'. VC
Facility Contact: 4Q G'_1 k-e,r' Title: Phone No:
Onsite Representative: S`C°� Integrator: C4
Certified Operator: '6, O / / Gl �A2-E�l 472— Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' 0 �" Longitude 0 0 ��
_. Design Current `Design :Current
--Shiite` , _.: Caisauri`-Poavlatioa- '•aPoaltrr Gaaaut� 'PooiilatioI
eederto Finish
❑ Farrow to Wean
LI Farrow to Finish
❑ Gilts
❑ Boars
" Number of Lagoons
HolcEiiig'11`- ds,45ohd Traps
Other
Cattle;:= Ca auto `Po -uladiiii
❑ DLiry I1
❑ Non -Dairy
otal Design Capacity
[] Subsurface Drains Present ❑ La non Area
❑ No Liquid Waste Management Svstem
irav Field Area
I
Discharnes & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes qNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes O No
c. If discharge is observed. what is the estimated flow in Rai/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �rNo
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 8�No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (incbcs):
05103101 Continued

Facilih- Number. 17V — _ZZ Date of Inspection
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes 99No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement? ElYes 4 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes A�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 1(No
WasteApplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence over application? , ❑ Excessive Ponding ❑ PAN ❑ Hydraplic Overload ❑ Yes INo
12. Crop type �.y, /- 5
13. Do the receiving crops differ with those desig4edin the Certified Animal Waste M gement Plan (C WMP)?
❑ Yes
,Q No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M�No
b) Does the facility need a wettable acre determination?
❑ Yes
oc)
This facility is pended for a wettable acre determination?
❑ Yes15.
INO
Does the receiving crop need improvement?
❑ Yeso
16. Is there a lack of adequate waste application equipment?
❑ Yes
,i'3+1a`
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WiiP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
§60
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments ( refer to -question-#) YESYans.rerssad/or'any reeommendstions'or any. otherr_ comments, x
„Eiiplaut'�aay
[use drawings of facility to better ezplaitt sitaaaous. (esse addtaana! pages as necesss ) - _
r5 Field Con ❑Final Notes z
Lam' tJ 'e'd 164, `i--c;
Q oa((cl recur I/I
(11;v1ter o&erSePj IS
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: I "ZZ _0 L
0310310I
Continued

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 8 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilin- lumber `DTime: ate of Visit: I
- - - - ,.� Not O erational Beiow• ThreshnId
® Permitted ® Certified [3 Conditionally Certified [3 Reuistered Date Last Operated or Above Threshold:
Farm Name: IVI �' I 4�l�rp�_ County: (Z 0 1.e-S0, _ �o
Owner -Name: QL hAr_1„a,c—'r, Phone No: Q%lQ l 244 602� —
Mailing _address: rnh4,� , iMM cA,r-i Qd
Facility Contact: 116,rf, Title:
Onsite Representative: t
Certified Operator: b MT., 0
Location of Farm:
Phone No:
Integrator: CL rre W11
Operator Certification Number: t T- 1, S 7—
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 9 4 " Longitude ' �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I I JE3 Laver I T I ❑ Dairy
® Feeder to Finish . ❑ Non -Laver I I J❑ Non -Dairy
❑ farrow to Wean
El Farrow to Feeder ❑ other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present ��❑ Lagoon Area Lj Spray Field Area J
Holding Ponds / Solid Traps ❑ No Liquid waste Managgement Svstetn
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If dischar,e is obsen ed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in sal/min?
d. Does discharge bypass a lagoon system'. (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier --
Freeboard (inches). 34,
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ]j No
Structure 6
Con hued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [�No
12. Crop type (,} o CCU
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA )?
❑ Yes
[S� No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
Wo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
2*0
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
QNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
El No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
UP No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[SNo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
50 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Camrments (rcier b question #fj: Erpiain any YE5 answers andlor any recotumendations or any other comments.
Use drttwbs� H Escllity to better ezphtin situations (use additional pages as necessary): ❑ Field Copy El Final Notes
Reviewer/Inspector Name MUMS. I
Reviewer/Inspector Signature: C Date:
05103101 Continued

Facility Number: —
Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours?
28_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e_ broken fan belts_ missing or
or broken fan blade(s). inoperable shutters. etc.)
,1. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks track a submersed fill pipe or a permanentltemporary cover?
Addition
❑ Yes ❑ No
❑ Yes No
❑Yes No
❑ Yes i] No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
O5103101

Facility Number 2 Date of Visit: -O/ Time: lQ'Lj
Q Not O erational Q Below Threshold
0 Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated orLAbove Threshold: ..----..... ....
Farm Name: ..._ `f T .. trht!��.................................................................. county:.... Q �l Q .....
Owner Name:...P fCl.� ..r.>......... ............'.' .L. c�.�...�............................ Phone No: ......
Facility Contact: �a —to.
Y...f _4 0. 4ZAX _.Title:.....Af&-L.......................... Phone No: ..... r� .
Mailing Address: __Z l .. tfili� t...%�!1r� ra< .._ ......................... ' . .-Pel {. C Z �3
_.
Onsite Representative:.....Ro ..... .5..V L............... Integrator:........
I
Certified Operator• E�+...acj,I „f Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• �64
Desiga . Current . Design Current _ Destgn ,' Curt�adt
Population . . Population ci ou, Ptloa -_
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish d d ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean ;--
Farrow to Feeder ❑ Other
Farrow to Finish - Total Des C pa-t 6
Gilts -
Boars Total SSLW _�
Npmber of Lagoons
&1d g Ponds / Solid Traps.:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Subsurface Drains Present
No Liouid Waste
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Lagoon Area ❑ Spray Field Area
System
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1
Structure 2 Structure 3 Structure 4
Structure 5
❑ YesANo
❑ Yes ZZ
❑ Yes
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes PSO
Structure 6
Identifier: ....................................
Freeboard (inches): X,1
5100
Continued on Lack

Facility Number: — Z Z Date of Inspection . p
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
closure plan? ❑ Yes
o
(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 /ENO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level (�
elevation markings? ❑ Yes
Waste Anvlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type 10ioe-mw ,, 4r- A ex-_ - / 1LJ .-1z4+v r &tm % cA�n i s /.>
13. Do the receiving crops differ with those desibiated in the Certified Animal Waste Mandgement )dn (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes Wo
15. Does the receiving crop need improvement? ❑ Yes ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes gNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes K-No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes f�,No
24, Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? []Yes I `�90
i�igjs:id0fj:jeces reqt eeviioWe}g1Qypitig i
.. icori-es ' denta�: a�otiti this visits . .. � - ' ' • ' • - - ' - - ... • .. .. . .
'CO
(re#er toggestian #) Eaplatn any YFS answ%rs and/or any-recodetioa4 or any other comments.--
Use drawings:of fa�ilitytti:hetterexpbun sitrsatia�t. (use _aclditii►inal:pages as necessary)^ _�--_ _ - ;;_ --
jJeed -z ce� a Sm:% S /c h 7 c c�'
74ere, ar-e. 5W74e es ♦ 1, /
C�e�oc(16w7 j� U e Y cL � f bcr Py t_• C4 CL
l� t{I( dk 4i 0t_+C ua4 -pt r•,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q SroQ

Facility Number. -ZZ Date of Inspection -p Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Ayes ❑ No
❑ Yes o
❑ Yes o
❑ Yes 1 J 0
❑ Yes No
❑ Yes
❑ Yes ❑ No
_ do mments;an orDrawings:- _ -- _ -- I. - - --
S/00

(] Division of Soil and'Water Gonservahon 'Operation Rer.ew
Division of Soil and Water:Conservation Com Nance llnspect>on - `�
- rr r^,x-•i�S'-5._..tti i r F,. •, h,� �'.i'.
Z Division of Water alt Compliance Inspecieon
A q w -
>'tr 3 C Other Agency Op£L8t10n:RCVtCwn.
Routine O Complaint Q Follow-up of
Facility Number ']f :,
inspection Q Follow-up of DSWC review Q Other
Date of Inspection IG 12 11_1/_?91/Z
Time of lnspeclion I 2' ya 124 hr. (hh:mm)
Iff Permitted [] Certified [3 Conditionally Certified. [3 Registered 113 Not Operational I Date Last Operated
_'t— /
Farm Name ! f �/¢il�— ... County:..---..... ....................... ....................
Owner Name:------.....J a/i.�✓ ...l�f...tG- i w .................... ._.... Phone No:......./...` ..... �. .:.. (..
Facility Contact: 1t.^1 -�....... Title: ................................................................ Phone No: ...................................................
Mailing Address: ..... L_.......�i...r...Qifd , /��!�........ /.. N............fo ...................
�,............ C _
OnsiteRepresentative Integrator: ..........................................................................................................................
Certified Operator:...
Location of Farm:
Operator Certification Number: ..........................................
i
.............................................................................. ........_.................... ............................... .__............. I..........................................
Latitude Longitude • �` �"
Design Current Design Current Design Current
: Cattle Capacity Population.' Capacity Poelatoelation .
❑ Wean to Feeder
Weeder to Finish
7& xo
o o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other - _ _ -
- T 'tal.Desigri Capacity
:_Total:SSLW
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ElYes o
h. If dischargc is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes, kNNo
c. If dischargc is observed.'what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes JNO
o
2. Is there evidence of past discharge from any part of the operation" El Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ElYeso
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /I
Freeboard(inches): ......... 3...................... .............................................................................................. I........... ............ I ........ .I............. .... ............ ...................
5. Are there any immediate threats to the integrity of any of the structures observed`? (iel trees, severe erosion, ❑ Yes N0
seepage, etc.)
3/23/99 Continued on back

Facility Number: 7,f -- ZZ Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated rn the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
*.*iQlatigtis:or deficiencies were hof tlu irig this;visit: You will rebi i Rio: #'urther . ;
:: Corresb6 idejhi& ab' this visit
❑ YesxNo
❑ Yes o
❑ Yes No
❑ Yes KNo
❑ Yes jo- No
❑ Yes Xo
❑ Yes )�CNo
❑ Yes K No
❑ Yes PNo
❑ Yes grNo
❑ Yes MNo
❑ Yes !�No
❑ Yes XNo
❑ Yes KNo
❑ Yes eXNo
❑ Yes Im
❑ Yes PTO
❑ Yes ; No
❑ Yes Wo
❑ Yes F No
❑ Yes PINO

Facility Number: — ZZ Date of Inspection
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KTNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )Q No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes %Jqo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANO

Information contained in this database is from non agency sources and is considered unconfirmed.
Farm Emergency Call Form
Farm Number
Farm Name M&T Farm
Owner Frist Name ohn H.
Owner Last Name McLean
OO Reporting O Complaint
Source ohn McLean
Date
-1-2000
Time
Call Humber
14
Breached
O Yes ONO
Freeboard Level 1 1 g
Depopulated
O Yes ONO
Freeboard Level 2
Overflowed
O Yes ONO
Freeboard Level 3
LQ Issue
O Yes ONO
Freeboard Level 4
PermissionToPump
O Yes ONO
Inudated
O Yes O No
Freeboard Level 5
Flooded
O Yes ONO
Freeboard Level 6
Pumping Equipment
O Yes ONO
Comments
with discharge pipes. Lagoon actually has about 2 feet of freeboard.
..........................................................................................................................................................................................................................
J...................................................................................................................................................................................................................

�V
❑ Dwrsron of Soil and Water Conservation Operation Review r
0' DE3v�sron of Soil and Water Conservation Compliance Inspection
r
{, Drvrsion;of Wa#er`Quahty - Compli nce Inspection ry
Other Agency. Operation:Reriew
112 Routine Q Complaint Q Folloiv-iyp of DWQ inspection 0 Follow-up
of DSWC review Q Other
Facility Number Z
Bate of Inspection Z— S-
-l-ime of Inspection / '.
24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified © Registered ❑ Not Operational Date bast Operated:
. ................
Farm Name- f 'Gir/n
' ._. ....�......... I ..............................
Countv: � e al, _
OwnerName:........ ..................................................................... ...../..!...�. &zc&�-Phone
No:....... u' v...............................................
Facility Contact: ..A .... 'title: ...................................
/
Phone No: ...................................................
,Mailing Address:.....,? 1 1 MD1J�c.
..._...... a.............................................M........r�...........r........N.....
C.. , 2?3..
�.`..
Onsite Represenhitive:..., �..��`� ........ /. /1.D.......... —C- �-.`..........................
...
/`
Integrator:.......... % .� .�.f L..�s.....................................
.c.
Certified Operator: .4, J�/ / �� ��
..........�.......................
Operator Certification Number: ..........................................
Location of Farm:
..:..................................................................... ..............................................:................................................ .
......................................................................................................................................................................................................................... ;
Latitude �• �° �" Longitude
bwme Uapacity Population
❑ Wean to Feeder
Pq Feeder to Finish 70 Vo
❑ Farrow to Wean
❑ Farrow to Feeder
it Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity -7p 40
Total SSLW-
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Dischargc originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c..1l discharge is observed. what is the estimated flow in ualhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3_ Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structure t
Identifier:
Freeboard (inches): :3
....................
Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes o
❑ Yes )kNo
❑ Yes 41No
❑ Yes )� No
❑ Yes E�NNo
❑ Yes 6'No
❑ Yes XNo
Structure 6
I/6/99 Continued on back

Facility Number: 7Sr — Z Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
4 seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
S. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings'?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? Ponding [I Nitrogen
2. Crop type u-..............................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14_ Does the facility lack wettable acreage for land application? (footprint)
15_ Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect,at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency'?
10. N.o.vio]ations.or deficiencies .were no e'd' d'uritn- :Niis_visiL _ Y_oti will.receive no further. :. :
c-orrtespotidefiee; about: this visit.- :. :. ..:::: : : :: : .: :. • : • : : • : • : • .: • : • : • : •
❑ Yes gNo
❑ Yes �`J No
❑ Yes
KNo
❑ Yes
ANo
❑ Yes
ONo
❑ Yes
kNo
❑ Yes
uWNo
...........................
❑ Yes
ANo
❑ Yes
JXNo
❑ Yes
fiq No
❑ Yes
A No
❑ Yes
1ANo
❑ Yes
KNo
❑ Yes
Wo
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
KNo
❑ Yes
JXNo
gnuneh6; (refer to question #): Explain any YES answers and/or any:recommindattons or any other comments `a r
se drawings of: facility to better explain situations. (use additional pages as necessary).= r
1...,...
QC%nf e- G� rwri��t / rcr1F- fps 1��.; y�� ene Q7` i i S �I /n� �c� , , j
i le Co. (11A- s}_). /
��`' lbiS�r Ttr-� �c1Er ' f li,ti ilt. �ar
Ccj necor S.
r �
U
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date: ! 1/6199

1 '
EMI0 Division of Soil and Water Conservation 13 Other Agency
R
Division of Water Quality N•
� � � �� .. ��' ., ::.::: ,� ., �- -:'� °�,;. .: `sic; �is`:�?a�... _ , �A� �''? �"�' � `... i � a''.�.��, s.eh a b
Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection ��
Time of Inspection E= 24 hr. (hh:mm)
13 Registered O(Certified © Applied for Permit A Permitted 10 Not O erational I DateLastOperated:
FarmName:------------------M..+ .. ....... � t'1.1t'............................................. County:......................I[ .Q.. ? 1 1...........................
Owner Name: .....................�.`n'-' .a..........1.'..K:.�4%x. ............... Phone No:./I.... 5�..v.`....v.i�..� ......... ------------A.�...
FacilityContact: J ..... ........��'>I,G .... Title: �j .-.. Phone No:
MailingAddress: .................. f..:........... �,K............... .... ...... ............. .............................. ......................�
Onsite Representative: .... . ...... kkt jlo..........------------- Integrator: ......... 1��/�-�---.�....---1.6.
1 y .-_ . C
Certified Operator: .............. ......................za�'�C!i..-----..... Operator Certification Numbers---------- ---- ---
Location of Farm:
Latitude • 4 « Longitude • ° "
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. if diuharge is observed, what is the estimated flow in-at/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes fX No
❑ Yes��
No
//fg
❑ Yes
J4 No
❑ Yes
ANo
❑ Yes
XNo
❑ Yes
RNo
❑ Yes XNo
❑ Yes j(No
Continued on back

Facility Number: — a
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
gNo
Structures (Lagoons.lioiding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
VNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier::......................................................:.........................:...
Freebow-d (ft): ................................................
................I..................
10. Is seepage observed from any of the structures?
❑ Yes
nA No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
M Igo
12. , Do any of the structures need maintenance/improvement?
❑ Yes
CKNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
i
13. Do any of the structures lack adequate minimum or maximum liquid level markers"
❑ Yes
No
Waste Application
14. Is there physical evidence of over application'?
ElYes
XNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
Crop 1
15. type ..........................
.........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
gNo
17. Does the facility have a lack of adequate acreage for land application.?
❑ Yes
No
A
18. Does the receiving crop need improvement?
❑ Yes
)4No
1.9. Js there a lack of available waste application equipment?
4
❑ Yes
E0 No
20, Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
jKNo
22. Does record keeping need improvement?
Yes
❑ ,No
For Certified or Permitted Facilities Only
,
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
,� No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J4 No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
JO No
0 No.violations or deficiencies were noted'during this visit. You.will receive no further
coerespondenee aboitt this.visit:: :
-ottriments.(refer, to question #): ,Explain any Y l:S'answers and/or a;nv recommendations or any other connnents . ' �-
Jse drawings of facility to better ezplain situati�irkJuse additional pages as neeessarv)y {�
01
Gh
vl_ ,
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7- n

0
HKROdtine 0 COMDIRInt 0 FoHow-uv of DWO Inspection 0 Follow-usi of DSWC review O.Other I
Date of Inspection
Facility Number Tim of Inspection 9:303Use24hr. time
Farm Status: C-efRill CA Total lime (in boors) Spent onReview
or Inspection (includes travel and processing)
Farm Name: T County:
Fl. MCLea 521 -.0e146j
Owner Name: 3o Phone No:
maning Address: 77 213
Onsite Representative: Integrator.
Certified Operator. — Operator certistatiourimber.
Location of Farm:
A
Latitude Longitude
113 Not P2eradoual Date Last Operated:
Type of Operation and Design Capacity
-S 8
WNUM
,
VVMumber e Ate.
Nwn to Feeder LzYcr
W
j
e
eeder to Finish Buff Non-la3w
w
VF Farrow to Wean t4s.
If
to Feedet
Farrow to Finish M E3 other Type of Lhvma
4i Y M.04 I
Subsurface' Drains Present
L Lagoon Area Spray Field Area
Pineral
1. Am d= any biffm that need mainb== rmprovcment? 13 Yes P(No
2. Is any discharge obsw4ed from any part of the operation? [3 Yes No
a. If discharge is observed, was the couvrfanm man-made? E3 Yes No
b. If discharge is dbscrved. did it mrh Surface Water? (If yes, notify DWQ) C1 Yes No
c. If discharge is observed, What is the estimated flow in gaYmia? "
dL Does discharge bypass a lagoon system? (If yes, notify DWI ) E3 Yes No
3. Is them cvidc= of past discharge from any part of the operation? OYes No
4. Was there any adverse impacts to the waters of the State other than from a discharge? 13 Yes o N
I
S. Does any pan of the waste management system (other than lagoons/bolding ponds) require 13 Yes No
mai ntcoan ceirmp ovement?
Coned 0 'AWwk

6. Is f wility not in compliance with any applicable sed ack txitriia?
7. Did the facility fog to have a certified operator in responsible charge (if inspection after llil9?)?
L Are there lagoons or storage ponds on site which need to be pmp * closed?
ctures�L.a s and/or Holding Ponds
9. is stmctaral freeboard less than ada*mw?
Freeboard (ft) J agoon 1 Lagoon 2 Lagoon 3
3. S"'
10. Is seepage observed from any of the ?
11. Is erosion, or any other ducats to the iatiegrity of any of the sftcturts observed?
12. Do any of the structures need ?
(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 StrutMzs Lack adquate markers to identify start and stop pumping levels?
Waste Ay�llcation -
14. Is there pbysical evidence of over application?
(If in excess of , or runoff entering waters of the State. notify DWQ)
15. Crap type P C"yVt �d
16. Do the active exops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
19. Does the cover crop need improvement?
19. Is them a lack of available irrigation equipm, my
r Certlirted FacUMCI ,QMJ
20. Does the facility fail to have a dopy of the Animal Waste Management Plan reaMy available?
21. Does the facility fail to comply with the Anima! Waste Management Plan in any way?
22. Does sem keeping need haprovcmeni?
23. Does facility require a follow-up visit by same agency"?
24. Did R,eviawerllasp =Dr fail to discuss review/mspmdon with owner or operator in charge?
r] Yes 01�,o
E3 Yes 9NO
13 Yes ONO
13 Yes o
Lagoon 4
0 Yes P(No
❑ Yes No
❑ Yes No
❑ Yes �No
t] Yes PNo
❑ Yes ANo,
0 Yes XNo.
0 Yes ANo
❑ Yes AN-?
Oyes 4io
❑ Yes / No
E3 Yes No
E3 Yes $No
❑ Yes gNNo
t,.omments (refer to question #� F-xP�:�Y YR.S answerx aadlor�y�r+xo�metidations�or aay:ather os� � .�
jam. .... r .•� ...
Use' drawings df faCilltj!•OD- betiCr ..+uL bttllatlflrlS siVSC auui{iofl81 �8ge.? ffiz •� r s # . f• .
fSr Px
Reviewer/lnspector Namem
Reviwer/inspecter Signature:
Z-Date
S—27
74 —
cc: Division of Water Quality,
aver Dualfty Sea mL Foeft,.l
a mment Unit
I I /I nmF

� ' State " of North Carolina
\\N Department of Environment, Health and Natural Resources
�� -� Division of Water Quality
5 �g9 Non -Discharge Permit Application Form / Survey
���� 0 , (THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
, PN � ere eral Permit Liquid Animal Waste Operations
FEE
The following questions have been completed utilizing information on i file with the
Division. Please review' the information for completeness and make any corrections
which are appropriate. If a question has not been completed by the Division, .please
complete as best as possible. Do not leave any question unanswered.
Application Date: 4 —?/l7 %
I. REQUIRED ITEMS .C_ HECKLIST
Please indicate thatlyou have read the following list of requirements by signing your initials in the space provided next to each
item.
nliciljJWpals
1. One completed and signed original and one copy of the application for General Permit - Animal
Waste operations; '
2. Two copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is disposed; L`t
t
3. Two copies of the Certified Animal Waste Management Plan (CAWMP). If the facility does
not have a CAWMP, one must be completedprior to submittal of a general permit application
for animal waste operations.
II. GENERAL INFORMATION:
1. Farm's name: M&TFarm
" I
2. 'Print Land Owner's name: John H. McLean
3. Land Owner's Mailing address:. Rt 1 Boz 277�
City: _Maxton i NC _ _ Zip:', 28364
Telephone Number: 521-0481
i
4. County where farm is located Robeson'
5. Farm Location (Directions from nearest major highway. Please include SR numbers for state roads. Please include a copy
of a county road map with"the location of the farm identified): n
83 south. go to the 2nd X-roads Sig 14' '1 and Gaf y's Mill Rd. = right go 1 mile on right.
6. Print Farm Manager's name (if different from Land Owner): /61, T,4,,,-
7. Lessee's / lategratoes name (if applicable; please circle which type is listed):
FORM: AWO-G-E - V97 Page 1 of 3

III: OPERATION.. INFORMATION:, -
1. Farm No:._ '" ' ' � . ;- � �' • . .. • I
�R_22
2. Operation Description: Swine on .
7040 -'Certified Design Capacity
Is the above information Correct? yes; 0 no. If no, correct below using the design capacity of the facility
k
-I= of Swine -No: gf Anfidds' ,I= of Poultry No, of Animals Tyne of Cattle No. of Animals
0 Wean to Feeder 0 Layer 0 Dairy i
Weeder.to Fmish764 o 0 Non -Layer 0 Beef
0 Far ow to Wean (# sow) 0 Turkey i
0 Farrow to Feeder (# sow) i
0. Farrow to Finish (# sow)
- Other :Type of Livestock on .the 'farm: a Nam- o. of Animals;
3. Acreage.cleared and available for,application: 71100 _; Required Acreage (as listed in the CAWMP): s
4: Number of L$goons: L ; Total Capacity: 1yy�g 2 S Cubic Feet (ft3)
Number of Storage,,Ponds: TotalCapacity. Cubic Feet (ft3)
5. Ts animal waste being applied on anyfieldwhich has subsurface drains? YES or(o (please circle one)
k
- 6.. Are subsurface drains present in the vicinity of or under the lagoon? YES or� (please circle one)
IV. APPLICANT'S.: CERTIFICATION:.:
T, __..—_. _. _ _ (Land Owner's name listed in question 11.2), attest that
this application for~
has been reviewed by me and is accurate and- complete'to the best'of my knowledge. I understand that if all required'partc of this
application are not completed and that if all regnired'supporting information and attachments are not included, this application package
will be returned to me as incomPlete..
_
5ignatare : - Date - 2 F Q -1
V MANA°GER'S 'CERTIFICATION: (complete only if different from tuc Land Owner) j
T, 1PA.ydriOtL r ��o,y,a s ..� (Manager's name listed in question II.6), attest that this
application"for
has beeuseviewed by me and is accurate'and complete to:.the best of my. knowledge I understand that if all required'parts of this
application arse not co�pleted and that if all'Iequired'suppq'm inforna.gon and attachments are not included, this apgliartion package
will be retmrued as inca�lete ` �"
Signature Date 3%2-
•THE COMPLETED APPLICATION PACKAGE; INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENTTO THE FOLLOWING ADDRESS:
12
NORTH' CAROLIIVA;-DIVISION OF WATER QUALITY
`;.WATERS QUALITY' SECTION
.+ " PERMITS ANIY1ENG_INEERING UNIT
POST OFFICE BOX 29535
RAI:EIGH-;,NORTH° CAROLINA 27626-0535
TELEPHONE 'NUMBER: [phone]
FO_ RM: 'AWO-GE 7J97 Page 2 of 3

WASTE'tUTILIZATION PLAN Revision
v -= ------------- ;
- fr.• !, r� a_ y iS �i T••r Wr't,.�21 T'r�C?1
- -• ^ SI.H Y � J. ►r+4.I.�T,'t -(4 )
_ Owners4name, `, YOHN"McL$AN Syr ''' J. •County:ROBESON
• ,4?`' `k"''{i1�:L"�S Y,'si'".5.wi.F f`t ri Yiyn,�"r� f�:"� f::S. �. ti .i'. _ 1
y ` ' : Maily�Addre'ss r'' RT=1`*EOX}�277MAXTO4NC 28364
_ Type of production unit---- :-SWINE
liTumlier rof animal sunits- .� 7040 - = -
�' ti tT' 1x
= jType of ;wist{d- facility ' , •Anaerobic Lagoon
s ra �> }fir '}fix c�.: * i`3 ,� r} ` i"i ~ `a i F • �� ` !
* Temporary}`storagL=T- eriod'~ /:.Y'18D days
j ' Method of application :IRRIGATION
-c,c�
Amount` of animal waste"produced_ - ='- _ _ _ _ _ _ _ _ _ 13376 tons/year r
.r `- "d r
r AAnouritof Splash available Naproduced by .animals- 16192 lbs /year
� rCommercialtN to apply on planned acreage-------- D lbs./year
r ,�z r r , N
3 NJ
; ,Your animalnwaste;uti2 zation,plan has been specifically
'developedforyour�swineroperation'::• ;The plan is based on the
-4soiltypes cropsto'begrown, ; `aiid' method. of.. application for
J, .your,,particular�operatiani .TheA:twaste imist: be land applied ;at a
specifiedratetotpreventpollutionof; surface .and/or;:ground
_ water 1 wsThe last anutr ents;`in `:the=:animal �waste a: shouldebe 'used to
r r'educd1the �yamdunt-6_o ommercial'" feiti'lizer. required for :the' crops
wiieice theaste"�istobea plied: �: ; This.a;waste .utilization ;plan
.x ¢_.g... gar .:
ea�;as,'�the�lisiit n nutrient',;,��_ Waste,-should�.be;�.
t,t.analyzed"befo=e ;each,;appl�icatioiicycle,_and annual ,soil:,tests
=�., are -,encouraged'�'so".�that;�•all-`,plant' nutrients can be balanced :for
' ., rehdistic`�yields of then cro]] p },to .be .grown .
r�i fJ � f I � *� i'✓y i 1r� i "J } � t
Several, factors are'µimportantYnimplementing your waste
r ! �a �utilizatioa plan;inw o'rde 'tay�maximize = the fertilizer 'value ;of
tie�°wasteand''to `ensured tliat�;it`is t applied in an '
i-eav�.ronmentally ,safe�rmanner A'lways,; apply waste based on -the
#needs frof,rtiiecrop;tobe;..grown�`and� the nutrient' content of the
"vraste :Do hots apply more, nitroged,, than the crop ,can -utilize.
rSozZ types:are x:importantasthey. have different infiltration
�r • ti 's rates ands leaching:potent�a�° r�rWaste shall not be 'applied •to
S
landeroding ;ate greater'`tian M5s'tons peir'. acre .per..year. Do not
_'_.apply �wastewx'on . saturated�soils,:or" on land when the surface is
5 frozen{= ' 8itiier` of L:theBe cohd tions :;inay�• result -iriN runoff to
,x surface waters; }WindF�conditions'should also be considered :to
avoids driYft and"downwind_'odOF�.problems To maximize 'the.. value
i •
of;� nutrients:; fors caropr production and;= to reduce •the, potential
:for,rpoll'ution,°==thewastesiiould be. applied to a growing crop : or
riot1,more Ethan = 30 � dai ' ',jpg o�to,�p�ant�ng . Soil incorporation
f of, ,waste will conserve, nut-rients� and reduce odor problems.-:
ri�3 f; ti x r J 1 r' ? i +r11y�.� e•,'E ��F�.
�Az- _

Page 2
Thevacr-esc-neededrttofapply�,the ,animal.:waste is based on ; typical
nutrient1contentafor 4;thisitypet;,of facility. Annual acreage
requirements Jmay,4be•.more sot less based on -;the waste ?analysis,,
report',tfor. your.;waste.tinanagementnfacility:
YOUR WASTE UTILIZATION,PLAN•IS BASED ON THE FOLLOWING:
-Tract -• - Field- •• Soil -., -Crop? r •,Yield Lbs . -N • Acres Lbs . N -Month to
No. No.i Type..Code° /Acre /Unit Used Apply
•50.00 41.0 11275 MAR-OCT
^� 10. -•, i1_. Mc, r-.C, .4 50.00 5.0 1000 MAR'-OCT
34966��- 11_-•WaB-- _' C, -- 5.5--50.00 _11.0 --3025-MAR"-OCT-
'34966 rf%Zj; LaB C ' -.4.5 50.00 4.5 1012,.5 MAR-OCT
�rw{—��--`tw?sia��'u��1rr-*•— ----- ---- ---=- .------
Total 61- 5 " 16313 '
Available Nitrogen' (includes commercial) 16192
C;r r ad in'by- w � _,._ `•), 4- Surplus Or Deficit -121z
Crop codes i `Crop ,unit'-"r�r=+.�.c ._ .
'A=Barley.-bu s I=Oats-bu.
X ii* de B=Bdraiudagrass1(grazeh"tonsavJ=Ry-e-bu.
tixn,-ir�C = Bermudagrass,,(,hay,));;,tons : K=Small -grain (graze.) -acre!
scr tDi Corn (grain):, bgrain (hay). -acre;
zi : ;$WCorn (silage);:,tons;te pv:�� M LM=Sorghum{grain} -cwt .
oOcrUrs FYCotton-lbs �telint 2-i"ye pW=Wheat-bu.. ,:
"Cv�t:if G-F,escue;(graze),-tonns'_bn app—iY=F,escue,{pasture} -tons .
Co
th e y+ H=Fescue.{hay,} :.tonsate ,t,�T-A,-, Z=Bermudagrass {pasture) -tons
Sp %A_alist :
i CCrjr� t�aCez'

r
Page 3
t
If more commercial fertilizer` is' used than shown in this plan,
then:additional :acreq,;of,'Iand';may,-j be needed.- A. tihree .to, fifteen
feet-. wide _peimanent`'grass` filter- strip should be •seeded• along all
ditches, -in fields',that•.recei�re`animal� waste.
Add-.tlonal comments +y
iwc.tu...4;R. M1.J.►! .,,}.�'�a °:� •t,'•.+�'s �i.y-. .yyam�
704
-- --- —i— --------,-- -- 1
ryijyV�'y}C' -- rig i i�.'.- ------------------------------------------------
or
.A?•ttiL�d�/3 �f tti
—. L 3.� i'S7 4.t� :C� i
it-���'L � 4:Jiw' �`a'a�e �M1.,t.,.�. �i C•� i, � Cat.+." " q 1• '' •'i Y�.� !t'iN 1 ,1r � lei — —, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _F — —
_ _� _ _
'.l!}.-.�•7L: �: 'ltl �-1e i� ,�}.�. LiJ�i.:cod—w•r---�•�_•___—___•____---t_—.._—__ f.r�
----------------------------
iJ...bl t prcdisc: d --- --- --- - - - -f� �r -- -
oe
Preparedjby-1 ,, -r' Title: ?Dater77
�S
Concurred -in' by: h4 _ Date: 111 S
?�:tii#t:s mac;, Tti�►.imG - Producer,,s +.
." ! ':3 :C•L:.3 "CJ F t.va 1 �� FF ' ' c• r `` - _
I; understand t} ate; musts*own or;Y}ave aceessbto equipment,,,
pr ma ily�' � rigation-equipment,ittoplandrapply. the,�animal•'.waste
-describedj,inz this wasteeuti'lizat_ion�,plan ,,This equipment must be
available; at;z;theappropriatepu�npng time, such,that no discharge
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US. DEPARTMENT OF AG R ICULTU RE SCS-CPA -16
SOIL CONSERVATION SERVICE
-81
CONSERVATION PLAN MAP
,01 Owner john McLean Operator Tract L10
County Robeson --State NG — --Date
Approximate acres 60 Approximate scale
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Cooperating with Robeson Soil & Water —Conservation District
Plan identification 78-94-34-08 Pbotonumber-ASCS # Al
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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
John H. McLean
M&T Farm
Rt 1 Box 277
Maxton NC 28364
Farm Number: 78-22
Dear John H_ McLean:
A46J
EDEHNR
February 24, 1997 EF"
FES 2 4 1991:
FAME ITTEV i LE
REG. OrRQE
You are hereby notified that M&T Farm, in accordance with G.S. 143-215.10C, must apply for
coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has
thirty (30) days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date.
Your application must be returned within thirty (30) days of receipt of this letter. Failure to submit the
application as required may also subject your facility to a civil penalty and other enforcement actions for
each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is'
incorrect please make corrections as noted on the application before mtuming the application package. The
signed original application, one copy of the signed application, two copies of a general location map, and
two copies of the Certified Animal Waste Management Plan must be returned to complete the application
package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Permits and Engineering Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any question concerning this letter, please call Andy Oakley at [phone]
extension 533 or Ed Buchan with the Fayetteville Regional Office at [phone]
M,�
A. Preston Howard, Jr., P.E.
cc: Permit File
Fayetteville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
John H. McLean
M&T Farm
Rt 1 Box 277
Maxton NC 28364
SUBJECT: Operator In Charge Designation
Facility: M&T Farm
Facility ID#: 78-22
Robeson County
Dear Mr. McLean:
e
EDE�HFZ
UFRMEo V
NOV 19 1996
ENV. MANAGEMENT
FAYETTEVILLE REG. OFFICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form trust be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc. Fayetteville Regional Office
Water Quality Files
IMT
P.O. Box 27687, C�
Raleigh, North Carolina 2761 1-7687 An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 _ 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources W;VWA
« • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor � E H N IR Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
'June 27, 1995
M & T Farms
Route 1, Box 277
Maxton, NC 28364
SUBJECT: Compliance Inspection
Robeson County
Dear Sir:
On June 22, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find encloW ., ctpy of ou- Compliance Inspection
Report for your information. It is the opinion of this offic- that this facility is in compliance
with 15A NCAC 2H, Part .0217, and that Animal Vrasit Mwi?ge nent is being properly
performed.
Should you have any questions regarding this matter, feel free to contact me at (910) 486r
1541.
Sincerely,
Michael D. Moody
Environmental Technician
MM/zlt
cc: Facility Compliance Group
Wachovia Building. Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal opportunity Affirmative Action Employer 50% recycled/ 1096 post -consumer paper

NORTH CAROLINA DEPARMWIENT OF ENVIRONMENT, HEALTH i NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Farm Name/Owner Inspection Date Farm No.
11
M A T Farms 1 22 June 95
Mailing Address
Route 1, Box 277
Maxton, NC 28364
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation t
Horses, cattle, E=70
. poultry, or sheep
SECTION II Y N Comments
1. Does the number and type of animal meet
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system) ) 710 D > x� ----
2. Does this facility meet criteria for Animal
Operation REGISTRATION? x_
3. Are animals confined fed or maintained in this
facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL WASTE
MANAGEMENT PLAN? x
S. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)? r_

_Administration and Program Management Comments
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc.c
SECTION III
Field Site Management N Comments
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of USGS Map
Map Blue Line Stream? _x_
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream? x
3. Does the facility have adequate acreage on
which to apply the waste? 61.5 acres
4. Does the land application site have cover
crop in accordance with the CERTIFICATION PLAN? max`
coastal
5. Is animal waste discharged into waters of the
state by man-made ditch, flushing system, or
other similar man-made devices? x
z
6. Does the animal waste management at this
farm adhere to Best Management Practices (BMP)
of the approved CERTIFICATION? max_
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approx. 5 ft.)
B. Is the general condition of this animal facility,
including management and operation, satisfactory? 1x` x
SECTION IV
Section II 15 - There has been no application of waste to land application
site as of yet. Lagoon presently has 5 `feet of freeboard and plenty of room
for additional waste. A copy of a proposed log for recording waste is
attached.
Section III tB - The condition of the facility is very good. Records were
readily available for inspection.

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
ESTED
John H. McLean
Rt. 1 Box 277
Maxton NC 28364
LT:.W;T,A
IT 0
A&4 0;
EDEHNR
April 21, 1994
Subject: NOTICE OF VIOLATION
Animal Waste Management System Registration
As Per 15A NCAC 2H .0217(c)
Robeson County
M & T Farm
Dear Mr. McLean:
AFC 27 J994
ENV. MANAGEMEN
FAYETTEYILLE REGCF
-
This letter is to inform you that the Division of Environmental Management received your
Registration Form for Animal Feedlot Operations on 2/28/94. This late submittal is a violation of
Title 15A of the North Carolina Administrative Code, Chapter 2, Subchapter 2H, Section .0217(c)
which required the registration to be received by the Division on or before December 31, 1993•
In addition to this registration requirement, please be advised you are also required to
submit an Animal Waste Management Plan on or before December 31, 1997, as per Title 15A of
the North Carolina Administrative Code, Chapter 2, Subchapter 2H, Section _0217(a)(1)(E).
If you need financial or technical assistance with regard to the development of your animal
waste management plan, you should contact your local Soil and Water Conservation District Office
at [phone].
If you have any questions concerning this information, please call Michael Wicker,
Fayetteville Regional Office Water Quality Supervisor at [phone] or Dianne Williams
Wilburn at [phone], ext. 233.
Sinc rely,
A. Preston Howard, Jr., P.E.
cc: Regional Water Quality Supervisor
Robeson County Soil and Water Conservation District
Robeson County Health Department
Regional Coordinator - NC Division of Soil and Water Conservation
Planning Branch
Operations Branch
P.O_ Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Information contained in this database is from non agency sources and is considered unconfirmed
Farm Efflergglacy Call Form
Farm Number
—
Date V-1-2000
Farm Name
IM&T Farm
Time I�
Owner First Name
O n H.
Call Number 1714
Owner Last Name
C can
p Reporting Q Complaint
Source
O n McLean
Plan Due Date Date Plan Date Freeboar
Inches
(7 equals blank) Received Level OK
Breached
Q es O No
Freeboard Lagoon
12/3/2
Depopulated
Q Yes O O
Freeboard Lagoonl
Overflowed
Q eS O O
Freeboard Lagoon3
LQ Issue
O Yes Q O
PermissionToPump
Q Yes Q No
Freeboard Lagoon4
Inundated
Q Yes Q p
Freeboard Lagoon5
Flooded
Q Yes Q O
Freeboard Lagoon6
Pumping Equipment
Q Yes Q No
Comments
aers .. x. a eiy.. ro.rn.................................................................. •....
...................................................................................................................................................................................................................................
of.wixh..�fsGk�axgo.pipo;��...i 9Q.on..�cfla ll.X his.albsaut.2.foek.l�f..fix. ek�o�xl� ........................
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