820014_INSPECTIONS_20171231

NUH I H C:AHULINA
Department of Environmental Qual

I ype of Visit: t& Uornpliance inspection V operation Review tj Structure Evamanon U E echnicat Assistance
Reason for Visit: 0O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: VS_Qt;r/_�1 Arrival Time: r fl Departure Time: �D County: ,SAS?( RegionF790,C
Farm Name: -Prvc Xjhe, j4- 7-- Owner Email:
Owner Name: 4r_,ALk!j � Phone:
Mailing Address:
Physical Address:
Facility Contact:
- LL4& `e_ Title:
Onsite Representative: Ll
Certified Operator: G r )0t_X
Back-up Operator:
Location of Farm:
Phone: r �,
Integrator: sn.
Certification Number:
Certification Number:
Latitude: Longitude:
-- --
Design Current;
. _
Design
Current
Design Current
Swine
Wean to Finish
Capacity P.op:
Wet Poultry
ILayer
Capacity
I
Pop.
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
Dairy Calf
Feeder to Finish
bO6 7 co
1"
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,onl
Ga aci
P,o
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
f
Turkeys
Other "
"t.
Turkey Poults
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 Ea_N ] NA ❑ NE
❑ Yes ❑ No aNA- ❑ NE
❑ Yes [-]No [D-N-A ❑ NE
❑ Yes
❑ No
[3-N-A
❑ NE
❑ Yes
1_5-;Z6
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: VL - I IDate of Inspection: IS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0_N'6—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):>fl
5. Are there any immediate threats to the integrity of any of the structures observed?
DYes�'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
U "'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
�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-N-o-
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
a<c
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to
❑ NA
❑ NE
mamtenance 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):
S &--ID
13. Soil Type(s): A45;, {
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q.Aia•❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (D-No—❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[q-Ner—❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ED-Na—❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Lam"" ❑ 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 [�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
i
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faeifit5r Number: IDate of Inspection. '
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B'g ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
I`T q-o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E3'N0❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
to ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑' 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?
❑ Yes
[q-NO ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[( N`6 ❑ 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
0''No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNW?
❑ Yes
E to ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2'1 o ❑ NA ❑ NE
C> ` ��; [ ]- � e 0�
�3A I_e,
L(S�
Ce,11 �[L-3�-6�SI
c
Reviewer/Inspector Name: t l
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�f�,,
Date: r/ l
214,12015

Type of Visit: 0 Compliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Qfollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r ZPr? Departure Time: 2 - p County: Region:
Farm Name: j�, V�� 2 Owner Email -
Owner
' fCC
Owner Name: Phone: REGEIVCD
v
Mailing Address:
Physical Address:
Facility Contact: Title: Af€vl WQROS
RESIeNAEGFRGE
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Ili
Design Current I
_
i Design
Current
E ��
.
Design Current
Swine
IE a
Capacity Popp
Capacity
Pop.
IN
,
Cattle
Capacity Pap.
y�WetliPaultry
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
'
`"
"�`II,
"''`
Dairy Heifer
Farrow to Wean
Design
Current'
Dry Cow
Farrow to Feeder
D Poult :
Ca aci
Pa
Non -Dairy
Farrow to Finish
Layers
',
Beef Stocker
Gilts
M.
Non -Lay ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
0'
x
Turkeys
EI
Other
�
r
Turke Pouets
I !
Other
��
Other
I
d�V
�
Discharges and Stream Impacts
_ 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 P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes La No
❑ Yes JE No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: L)-
-1
Waste Collection & Treatment
A. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
V j No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes]
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
[] PAN [] PAN > 10%or 10 lbs. ❑ "Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
� NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
[:]No
❑ NA
[A NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[A NE
I S.
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
M 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
6� NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[1� NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[� NE
Page 2 of 3
21412015 Continued

jFaci4ty Number: I Date of Inspection- U
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 ❑ No
the appropriate box(es) below.
❑ Fai lure 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
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
❑ Yes
❑ No
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA NE
❑ NA NE
❑ NA �j NE
❑NA NE
❑ NA X NE
❑NA ®NE
❑ NA ❑ NE
❑ NA ZINE
❑ NA I NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments ft,�fer to a y y other comments.
Use drawn 'offaciIin�to betteex lam situatidnv(� )'
ExplainY useers.aa or an addihonaI taco
facility P answers dditionai pages'as necessary recommendations or an o y
Reviewer/Inspector Name:
Reviewer/Inspector Signature: _z7z�
Page 3 of 3
Phone: y�f�' 7f6 -7336—
Date: 6 V" �/% 8
2141201 S

��` '�"��Division of�Water Reso"`� ui=ces
'"Facility Number ,1 ®Division of:Soil�and Water Conservation
,. _ QOt �he,�r�Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: C�0 County: -7 [ Region: 1 `zo
Farm Name:Owner Email:
�_
Owner Name:-rerlvl Q:wtc C��N� Phone:
Mailing Address:
Physical Address:
Facility Contact: •U j'Av"-5 Title:
Onsite Representative:
Certified Operator-
Back-up Operator:
Location of Farm:
u
Latitude:
Integrator:
Phone:
f' S
Certification Number:
Certification Number:
Longitude:
Design Current
�Swtne Capactty .Pop.
r: De5�gn Current° Design Current
Wet$Paultry Capacity 4SPop.r Cattle• Capacity Pop.
Wean to Finish
10
1j 17
Layer
Dairy Cow
Wean to Feeder
S
7
Non -La yer
Dairy Calf
Feeder to Finish
T
"""rc Design Current
Ca
La ers
Daig Heifer
_
Farrow to Wean*
Farrow to Feeder
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Boars
Non -La ers
Beef Feeder
Pullets
Turkeys
Beef Brood Cow
Other
-.
l
Turkey Poultsm
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[t'"NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E2<A
❑ 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
ff No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - FJ Date of Inspection:
Waste Collection & Treatment
4.•Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�JZvo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[?r<A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure ti
Identifier:
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a{j 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. 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
V�I(No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ 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
[fNo
❑ NA
❑ NE
maintenance or improvement?
11. [s there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FXNo ❑ 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): 0 4J 1 S, .."A 5 6 0 5,'+ 1,L)/T
13. Soil Type(s): Ale wa.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [R'No ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage R Permit readily available?
❑ Yes
ETNo
❑ 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
[ZI'No
❑ 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
ENo
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: PIZ: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? n Yes 2<0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9-1 o
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 2<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C -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 ONE
DNA ❑NE
❑ Yes [DNo ❑ NA ❑ NE
❑ Yes [ r&o ❑ NA ❑ NE
❑ Yes [�3`No ❑ NA ❑ NE
❑ Yes E21*4o ❑ NA ❑ NE
❑ Yes
[rNo
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
[/ZNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C40 o-16.
S�
7,
Q -3
\c Lc C(
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Cell 2'ro- 3o8- � fs(
Phone: '43. - S 3
Date: 3
21412015

l
teRoutine Type of Visit: U ComInspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / D _ Departure Time: J a County: Region: P7P1D
Farm Name: 7v+ �d,,,,� a., ry -- Owner Email:
Owner Name: iZ �r2 Q.—,.�_ Phone:
Mailing Address:
Physical Address:
Facility Contact: !� �-•�— Title: �/Jr� Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: Al, Z;1%
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Non -
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation`'
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
� N .
❑ Yes [''No ❑ NA [] NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E2 No
❑ Yes Ej No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

A
I Facility Number: - & Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®. No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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.)
Structure 5 Structure 6
❑ Yes 5�No ❑ NA ❑ NE
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
g� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
54,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
ELNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes �o ❑ 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): b rr`yyJA ar/ . / eg'/' ! :re j
13. Soil Type(s): U J a
14. Do the receiving crops til'iffer from those designated in the CAWMP?
❑ Yes
21 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�ZNo
❑ NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
1K No
❑ NA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available'? If -yes, check
❑ Yes
M 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 N 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0-No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

t IFacility Number: litDate 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 allo ❑ 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 5�,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®. No ❑ NA ❑ NE
[] Yes g No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA FINE
❑ Yes allo
❑ Yes ONo
❑ Yes allo
❑NA ❑NE
DNA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paijes as necessary).
Reviewer/Inspector Name:
Reviewed]nspector Signatur
Phone:
Date:,] �2-/— /7
21412015
Page 3 of 3

L
CI,-51A -3
Type of Visit: U Compliance Inspection U Operation Review U Structure Evaluation U 'Technical Assistance I
Reason for Visit: CfkLtine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /fr Arrival Time: ; /,57Departure Time: ,' County: Region:
Farm Name: �S K y!'�=--- t�Gt ��^- Owner Email:
Owner Name: u 2 R Phone:
Mailing Address:
Physical Address:
Facility Contact: cis Title: �a 1,7 ✓ Phone: /
Onsite Representative: ,�a K.�r Integrator: �jl7 it�e✓.
Certified Operator: Certification Number: �% 6 �� 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pap.
Wet Poaltry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
-
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
airyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.aal
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Won -Layers
Beef Feeder
Boars
JPullets
Beef Brood Cow
MUCH,.:
Turkeys
Qtlter
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
D 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
V•No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

- Facility Number: - I T)r IDate of Inspection: —/51-
A
Waste Collection & Treatment
r 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R 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): 7-0
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rM 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
[Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[R 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): //rfa/0 U �r
13. Soil Type(s): �/ �,..__ t-Ap /A
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
[a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® 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? 1f yes, check the appropriate box below.
C] Yes
r�7 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
0 Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5-gi No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection: 3 — *` l
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 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [NNo
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [allo
❑ Yes [g No
[::]Yes CA_No
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
J Tp- - r
74—
Reviewer/Inspector Name:��!���"`
Phone: 9 j1 / 3�
Reviewer/Inspector Signature:
Page 3 of 3
Date: 3--1
21412014

' — s— y— 15 cv
isioa of Water Resources
Facility NUMr - /y O Division OttSoil and Water Conservation
Other Agency
Type of Visit: ompliance 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:T:'3 Departure Time:County: Region:
Farm Name:_ . j � S % nX Ajakenz—d� Owner Email:
Owner Name: Q ` n hq rrt Phone:
Mailing Address:
Physical Address:
Facility Contact: e� �� ` nX A&Lrm- Title: 6Cc"'M Phone:
Onsite Representative: 4S Integrator: W YrA atrVW
Certified Operator: S Certification Number: l 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
_
Swine
Design Current
Capacity Pop.
V4'et Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
Ga er
Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Qa
D . P,oui
Layers
Design
Ca aci
Current
P,o
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Da'
Farrow to Finish
Beef Stocker
Gilts
Non -La era
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
FT-0
Turke s
TurkeyPoults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes ®.No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes gj§, No 0 NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - f Date of Ins ection:
7�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 2,0
Observed Freeboard (in): 499=--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 9=emj_o�
13. Soil Type(s):
14. Do the receiving cropsPdiffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
[:]Yes
(N—No
❑ NA
❑ NE
❑ Yes [!.No ❑ NA ❑ NE
❑ Yes [R 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 CKNo ❑ 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. jj?�Yes 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 [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: - Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Uj�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 M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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 CR No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes � No
❑ Yes [BNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft: Explain any YE5 answers andlar;-any additional recommendationsxor any other -comments+
Use drawings of facility to better explain situatioas,(use addit,anal pales as necessary). f
N -= L GcrxyL4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: � Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4�- Arrival Time: L`-`--� Departure Time: �'� County: �J(,w1l�Slh
Farm Name: PaSsi�h am Folm Owner Email:
Owner Name: v v d" `j Phone:
Mailing Address:
Physical Address: 35a1 Q}ire k1l
Facility Contact: 71L
Onsite Representative:
Title: O#n&_— Phone:
Integrator: H
Region: y 'RQ -
Certified Operator: PV4 � f(j jS b4 Arw7 Certification Number: �p gal
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
4 Destgn Current
01-
Dgn Current
Design Current
Swine Ca aci Po
P t3' P•
Wet Pou1 Ea aci Po Cattle
P h' P•.
Ca aci Po
P ty P.-
Wean to Finish
Layer Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
15MO
Dairy Heifer
Farrow to Wean
Desie-n
Dry Cow
Farrow to Feeder
D . P.oul Cci1?0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Witierisy
Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes S No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

i
Facility Number: $a = r t J Date of Inspection:S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a 1 A Mr -
Spillway?:
Designed Freeboard (in): C—
Observed Freeboard (in): =-2-
5. Are there any immediate threats to the integrity of any of the structures observed? [] Ycs 53 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
[5�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
ta No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Eq No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
5D 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): C.Qt"odcPoilve'
13. Soil Type(s).VQI�!nt
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 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?
5g Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 5j 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
21 If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[RNA ❑ NE
Page 2 of 3 21412011 Continued

+FuMty Number: - (q I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R1 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r`No ❑ NA ❑ NE
the appropriate box(es) below.
24
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
fR NA
❑ NE
❑ Yes
§a No
❑ NA
❑ NE
❑ Yes 153 No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes 'R No ❑ NA ❑ NE
❑ Yes fg No
❑ Yes ® No
[-]Yes 0 No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Gut r4l i� Old- O-e- uuC 0'�- COv; e
�y, P recaii wzt� reel l 1 st—r�� fc-jdI�r/rii .
I. P1e6e ckaye, 102 ocfober S fl- ewA+ '9 hAa- Cly
Coal recofdr-exC�pf as �o. a 6®��
C004- 1 ay9o, Cover,
Reviewer/Inspector Name:} 6 4 h p � -Pr
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qlo-g33 -33-0+0 "(i�,liC�
Date:
214 011

.6 _
Facility No. $a`lLl Farm Name PO-M�h Date 3
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dro s
La oon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth fit
Liquid Trt. Zone ft
,
Ratio Sludge to Treatment Volume if> 0.45
5-30
out of compliance/ POA?
,qo
Date
—ActualCalibration
•
■Y���-----
Actual Diam,
Soil Test Date Q
pH Fields
Lime Needed 011 _-
Lime AP lied
Cu-I Zn-1
Needs S (S-1<25)
Crop Yield
Wettable Acres L,,
WUP ✓
Weekly Freeboard
1 in Inspections
120 min Insp.
Needs P
- - ..-
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
NORA
.!
MIN Rww���..
r
Mo
p
Mu3T CC;r rAy U(tP Ir rnve- -fi X-,)
Verify PHONE NUMBERS an affiliations
Date last WUP FRO' _5�f1v300� FRO or Farm Records
Date last WUP at farm Lagoon # 90Q30
�AppV. Hardwgrerb-7 Top Dike �D
Stop Pump
Start Pump
�f:-7=1q
Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
C" -it Lz��
-rook obi Doo
C4(Off— O� &70f? ' '�

W
i;�Iulf2
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint 0 Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: p ; u >~ County: 5�9 tAs Region:
Farm Name: Owner Email:
Owner Name: �G`s� Phone:
Mailing Address:
Physical Address:
Facility Contact: ; ' aS51 bm Title:
Onsite Representative: 11
Certified Operator: 11
Back-up Operator:
Integrator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
-
Desi n Current. D t xC Design Current
gay* es gri ur end
Svvtne
CapaeityPop Vet Poultry _ - Capacity�Pop _.. Cattle Capacity Pop.
-=
�- -
La er Dairy Cow
Wean to Finish
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
U00
- - -
llesign Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
MCa aci - =: Po
Non -Dairy
Farrow to Finish
Beef Stocker
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other` '
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 1 ` No ❑ NA ❑ NE
❑ Yes ❑ No [)3 NA ❑ NE
❑Yes No [�NA ❑NE
[:]Yes []No
❑ Yes ® No
❑ Yes No
® 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 P No
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No
[DNA ❑ NE
® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes §D No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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
VC No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
�R No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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): C C�xt55 01n,,� lQs-> �► �_� d i;-a,,-kJ
.mil -
13. Soil Type(s): �,'JDr' . �ju"Ar-�, C;irQ —w
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
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA 0 NE
Page 2 of 3 21412011 Continued

Facili umber: jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vj 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 (8 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [34 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? ❑ Yes P No ❑ NA ❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [3 Yes FC] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J71 No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes CR No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
Phone: `%/C -1359V
Date: 1 �/
2112011

Type of Visit: 1p Compliance Inspection 7D Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 16 Routine O Complaint O Follow-up O Referral Q Emergency O Other C) Denied Access
Date of Visit: fArrival Time: Departure Time: %��r. County: �A Region: Fleo
Farm Name: �Q�SI/lQ1lQf'+� Farm Owner Email:
Owner Name: �t�/1 Phone: 1 a-�YL—a,31
Mailing Address:
Physical Address:
Facility Contact: ATitle: Phone:
Onsite Representative: U Integrator: /Ntl"A)
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
EC2apacity Pop.
W 6 tv Poultry
Layer
Design»
C To-g
I
Design
C•_a .acit.
Current
Current
.P,o
Design Current
I Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Wean to Feeder
I INon-Layer
Feeder to Finish
Farrow to Wean
Dr I?,oult , d
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
lBeefBroodCow
Boars
Pullets
Turkeys
Other Turkey Poults
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 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 ;Q No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Pad,*e .1 of 3 21412011 Continued

facility 'Number: Date of Inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: _ 1�
Spillway?:
Designed Freeboard (in):
a
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
77 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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes M 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 ManurelStudge 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): WQGjfZLrn -- t
14_ Do the receiving crops liffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
❑ Yes TP No ❑ NA ❑ NE
❑ Yes �j No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ 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 No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection- oZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T 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
Qg No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
fj4No
❑ 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?
Y-.6e,+r4 , mcu-bte @ nccEenr. joJ
91O- g33--3335
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes M No ❑ NA ❑ NE
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
[:]Yes* No [] NA ❑ NE
❑ Yes E�) No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: _YQq9
Date: f
21412011

Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: D D Arrival Time: Departure Time: 1 di County: 5'T"-t SD/`1 Region:
j r 1
Farm Name: 1 s C y Owner Email:
Owner Name: lowrl L C _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
u
Onsite Representative: ��/�
Certified Operator: K �� -j=g
Back-up Operator:
Location of Farm:
Phone
No:
Integrator r f w1,0� f
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ ' ❑ Longitude: ❑ Q ❑ ❑ u
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Desioign C►urrent
C*attle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish
Q
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
El Farrow to Wean
%Farrow to Feeder.
❑ Non-Dalry
Farrow to Finish
❑ Gilts
❑ Boars
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cowl
❑ Turkeys
D urkey Poults
Other
Number of &fractures:
❑ Other
❑ 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)
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 P No []NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
0!�NA
❑ NE
❑ Yes
❑ No
❑ Yes
.Y No
❑ NA
❑ NE
❑ Yes
IPNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection D o
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 S St eture 6
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): �7
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ElNA
❑ NE
through a waste management or closure plan?
T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
tJ
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes T No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Drift A pI.cation Outside A�re�a
Wind
Q❑
12. Crop type(s) `-�C� jj. ,/��[A� 40 � � C, f � 1
Doff
� c(9�
13. Soil type(s) IV o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[jkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I�R No
❑ NA
❑ NE
Cotmiients refer to ueshon. # Ex lain any .YES answers and/ any` recom�iie"ations or any other comment's
g (use additional pages as necessary):
�..
Use drawings of facility to better ex lain sttuahons
Reviewer/inspector Name I IYWLOKI Phone: .S" I
Reviewer/Inspector Signature: Date: b v}
12/2R/Od C""linurd

Facility Number: 9T714-1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ElNE
the appropriate box. ElWUp [IChecklists ❑ Design ❑ Maps [IOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T_ No ❑ NA El NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis El 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 05 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No EANA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
j;�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J�jNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�,No
❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes IFNo ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint o Follow up o Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: (� rp �f7fJ A = Arrival Time: n9 County:
Departure Time: Oa.
Farm Name: �Jd�r T7'J , c � I � l/� �ff_ Owner Email:
Owner Name: 1 'lr�'-r �(�VtOr �t�l tit _ Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
�r
Onsite Representative:
Certified Operator: Te"',''xyj
Back-up Operator:
Region:
Phone No:
ALtZ04-7Integrator:r►'J ZZ144't Iq C
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ' = u Longitude: = o = I = u
Design Current
Design Current
Design Current
Swin Capacity Population
opulation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
I I
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
91 Farrow to Feeder
❑ La ers
❑ Non -Dairy
El Farrow to Finish
❑ Non -Layers
❑Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
El Beef Brood Co
Other
❑ Other I
❑ Turkey Poults
JE1 Other
Number of Strictures
Dischary_" & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
fA No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
U NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
O NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
RNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ElNE
Struc �1 Structure 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
OObserved Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V9 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 allo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ 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 ;M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evide of Wind Drift ❑ Application Outside of Area
12. Crop type(s)5
13. Soil type(s) /1/�1,���0 �(�r �li✓
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
1PNo
❑ NA
❑ NE
1P No
❑ NA
❑ NE
No
❑ NA
❑ NE
EP No
❑ NA
❑ NE
`jNo
❑ NA
❑ NE
Comments (refer to questron #): Explain aiiyYES answers and/or any recommendations or any other comments.
Use drawings of facilityto better explain -situations: {use additional pages as'necessary,):
Reviewer/Inspector Name �-777
- Phone: q1C'�i�3 330d
Reviewerlinspector Signature: Wit& Date: O L9 p
12128104 Continued

Facility Number: Date of Inspection 2 D
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ED No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
53 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes OWNo
&INA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
73 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ll No
RNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�3 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
MNo
❑ 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
[�bNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
*1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
(UNo
❑ NA
❑ NE
12128104

Type of Visit • Compliance Inspection Q Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: :%SQL County: S41Mr� Region: r-RV
Farm Name: ` Owner Email:
Owner Name: / ' riy L Phone:
Mailing Address:
Physical Address: ��??
Facility Contact: �A Ca'r-e- Title:
u
Onsite Representative:
Certified Operator: 3jce_rl
Back-up Operator:
Phone No: Q
Integrator:
CJ�"IX.JY) , LAC
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: ❑ 0 0 = ❑ a Longitude: ❑ ° ❑ 6 ❑ 6{
Design Current Y' Design Current
Swine `= Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ La ers
Dairy Heifer
❑ Dry Cow
Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
1qCQ
il.4W
❑ Farrow to Finish
❑ Beef Stocker
❑Nan -La ers
❑ Pullets
❑ Turkeys
❑ Gilts
❑Beef Feeder
❑ Boars
❑ Beef Brood Co
gym.,.. A
Other d
Number of Structures11111111
urkey Pouets
❑ Other
❑ Other
-:.
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
FNo
[
ElNA
ElNE
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
IONA
❑ 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
73 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rpNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t$CNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No M NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: oZ 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):3 4
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 23No ❑ 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 22)NO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 Pg 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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
04)No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
fgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
§jNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Reviewer/Inspector Name " "' Phone:
Reviewer/Inspector Signature: Date: f�
Page 2 of 3 12/28/04 Continued

Facility Number: a2 Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes W)No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes "" No ElNA ❑ NE
the approprrate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes K)No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [PNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
{INo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
q.No
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
19 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
[QNo
❑ 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
R9 No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number IB)L- l O Division of Soil and Water Conservation
O Other Agency
Type of Visit ! Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Q S Departure Time: %I �r/�►2vti County:
Farm Name: ��� 8 ► cm Owner Email:
Owner Name: U'a �41 i 1 Phone: _
Mailing Address:
Physical Address:
Facility Contact: ca"r+r Title:
Onsite Representative:
Certified Operator: VorWT
Back-up Operator:
Location of Farm:
Swine
Region: �7
Phone No:
Integrator: &-ow "t
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 L = Longitude: 0 0= t 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I_I _
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Q
Farrow to Wean
Farrow to Feeder
1 t{ `7 18
Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ her
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population ;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E
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?
M
❑ Yes f] No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
4lA
❑ NE
❑ Yes
❑ No
❑ Yes
$ No
❑ NA
❑ NE
❑ Yes
fffNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -SENT Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FpNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (%NA ❑ NE
Supcture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /21
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA [INE
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 P 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)
4. 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 E� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19 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 Dri1fl El Application Outside of Area
12. Croptype(s) �v.,.� ���, )
13.
Soil type(s) Ah
& WQ�
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
No
ElNA
❑ 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
T" No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use dra%ings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: -F - 3 DO
Reviewer/Inspector Signature: Date:
i21Z&U4 ruonanuea

Facility Number: —b I q j Date of Inspection 9 3 0
Required Records & Documents gyp,
19. Did the facility fail to have Certificate of Coverage & Permbg
Pen -nit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'n No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &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
'� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0SNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ISNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;2�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P 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
04No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
Mo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

R
Type of Visit 49 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine ( Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �.A�Aw• Departure Time: C
Farm Name:
Owner Name: Aa 8/1fxjV 1
Mailing Address:
County: -Soy` Region: E+ 0
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
(lncira RanrPCPnfnNvw• U I mMu" rator: / ►' u" r�1 _2
Certified Operator:
Back-up Operator:
g - _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = = H Longitude: = o = I ❑ "
DesMil nmcnrr
Swine Capacity
ent
Pap In 'on �'�'et Pouitr3'
Designs'Current
CapacrytP�opulation
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
iry Cow
❑ Wean to Feeder
iry Calf
Feeder to Finish
Dry Poultry
j
Y �=
Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
Farrow to Feeder
4 Cz
Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Turkeys
❑ Turkey Poults
❑ Other ❑ Other
❑ Bcef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1�1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
O NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
ONA
❑ 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
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Date of Inspection rt5
Facility Number: —
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
JR No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: dui q� Ct �jr,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
$3 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[5�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rM No
❑ NA
ElNE
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
4 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
W No
❑ NA
❑ NE
wn
'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): ¢ 'w
Reviewerllnspector Name
d i
Phone: 0� TF -3 -;CV
Reviewer/Inspector Signature:
Date:
Page z of J 12.128/04 Continued

Facility Number: — 4j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 171 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [I Yes f] No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1p No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
[�9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
❑ NA
❑ NE
Additional ComnieQts and/or Drawings:
Page 3 of 3 12128104

H H
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: 1 A ! Arrival Time: Departure Time: County: Region: rleo
Farm Name: 2y Owner Email
Owner Name:_ _:mil -A L Phone:
Mailing Address: P'n C� _. _ ,'�JY,_,I- -t,�} , �jG 2es? 9
Physicat Address:
Facility Contact: Title:
Onsite Representative: {_
Certified Operator: i` Ct
Back-up Operator:
Location of Farm:
Swine
❑
Wean to Finish
❑
Wean to Feeder
LIFeeder
to Finish
eroap
1
❑
Farrow to Wean
arrow to Feeder
i zf Q d
❑
Farrow to Finish
❑
Gilts
❑
Boars
� //Phone No: pp
Integrator: ::12 `s`s'�r�
Operator Certification Number: -
Back-up Certification Number:
Latitude: = o = = Longitude: 0 0 = s = fl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑Layer
❑ on-Layet � I-
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
OTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
i
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 No ❑ NA ❑ NE
❑ Yes
❑ No
91 NA
❑ NE
❑ Yes
❑ No
E-NA
❑ NE
C�NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

[Facility Number:
Date of Inspection �f Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No VNA [INE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �.2 t Cow li.--
Spillway?: ►'L A 0
Designed Freeboard (in): CtI
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 14No ❑ 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 gNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1:71' No ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ 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)
13. Soil type(s)
q -a
14. Do the receiving crops differ`frok those desig�eld in the CAWMP?
❑ Yes
Wo
❑ 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 acre determination'
❑ Yes
�TNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
3.No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
6o
❑ NA
❑ NE
Comments (refer to question #}: Exglain any PIES answers andlor any recommendations or any other comments
Use drawings of facttity to better explain situations. (use additional pages as necessary}:
� � - � �' � �]i J•L_ r�
l � ' lam. �J rt'�t-4l � �'t,. vim- : � �-�C7Vh•4�-� i'� t; t
LS
1�,�
��c7 +nip c1 �:.ir- d'1i r I i! Cq8
✓ L' �^� Tyr 1"'
,:'{1
f
Reviewer/inspector Name r I Phone:
_
Reviewer/Inspector Signature: Dater; z (��
Il128/04 Continued

'Facility Number: ;c, — r Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ( No ❑ NA ❑ NE
the appropirate box.
❑ WISP ❑ Checklist' ❑ Desigx- ❑Mope- El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )UmjrNo ❑ NA , ❑ NE
❑ Waste Application"❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis,❑ Waste Transferse-❑ Annual Certificatio2-
❑ Rainfali' ❑ Stockings❑ Crop Yield-'[] 120 Minute Inspectim s ❑ Monthly and 1" Rain Inspectiotr'❑ Weather Codes
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
F No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
&To
❑ 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
El 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?
El Yes
�No
El NA
El NE
Additional Comments and/or Drawings: ))
12128104

[Type of Visit 4W Compliance Inspection O Operation Review Q Lagoon Evaluation 1
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 3 : 1 S nae: l�LL.L_LJ
Facility Number a2 O I
Q Not Operational Q Below Threshold
M'Permitted O'Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:-------
r
Farm Name: a County:
Owner Name: --................................. ....
-Mailing Address:
PhoneNo: . .. .............. . . . .. _.............. ...............
Facility Contact: _-- Tide: . Phone No: . - - ........
Onsite Representative: , ,ofir :T f_ _ _ ^, Integrator:
Certified Operator:.......!.. , L...................... ............................. Operator Certification Number:.... aAa„`� �i0_�._.
Location of Farm:
i
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CM No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: / ................. _......... ..a............_...._. .... _........ ......... .........
Freeboard (inches): .3SA' .38 a
❑ Yes ❑ No
u//f
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
® No
[I Yes
f] No
Structure 6
12112103
Continued

4' Facility Number: g,1 — O/r
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ute�,su�_ �.►... C2 .Pa Z t cQ. .SM.1 f 4; r .s
❑ Yes M No
❑ Yes [XNo
J9 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes fo No
❑ Yes Q9 No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes [P No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes It No
16. Is there a lack of adequate waste application equipment? ❑ Yes *No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [N 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 M 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 L9 No
Air Quality representative immediately.

f Facility Number: gp j. _om Date of Inspection ii /T fir/
Required Records & Documents
21. Fail to have Certificate of Coverage & General Peratit or other Permit readily available? ❑ Yes 1;0 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes [X 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?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
[]
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
q No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
I,No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
P 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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form .
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

NORTH CAROLIM DZPARMgl-- S OF E."Ftir ROh?Y--'Pi, E ALTE & NAMAL RFZOURCF-S
DIVISION OF LNViRONK--NTAL HAMAG "—qqT
Fayetteville Regional Office
Animal operation Compliance Inspec=i= Forte
IRK
�flS
7
-74T,nR?5s
3¢-
All questions axiswered negatively will be discussed in sufficientc'eta_I in
the Comments Section to enable the deemed Fermittee. to perform t1he a_ prop..: }ate
corrections:
SECTION I
imal Operation T
Earses, Cattle <Sain Poultry, oa- sheep
SECTION II
�M"
7. Does the n=aber and type of anal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), Sheep (1,000), and
Poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal. Operation REGISTRATIOM.
3. Are ani rnais confined red or maintained
in this facility for a 12-month period?
4. Does this facility have a gn�� AN729AL
WASGZKENr PLAN'
5. Does this facility maintain Waste management
records (Voluaes of manure, land applied,
spray irrigated on specific acreage With
SpeCifiC cover crop)?
S. Does this facility meet t-he SCS min -;Mum
setback Criteria for neig'r�cring houses,
wells, etc?
4

j VL 14 ' J._/ " • N4ri i
S�io�t rxr
1
I. Is am nal waste stockpiled or lagoon
coast_.zcwion with.:n 100 ft. 0- a IISGS
Map Blue Line Strezm?
2. Is ar_inal waste land a=plied or spray
irrigated within 25 ft. of a USGS Man
Blue Line Streaa?
3. Does this facility have adequate acreage
a:Y which to apply the waste?
4. Does the land application" site have a
cover crop in accordance with the
MTi ICATIQN PLAN?
S. Is anima? waste discharged into waters of
t*he state by ==-made ditch, flushing systen,
or other similar man-made devices?
S. Dees the animal waste management at this
f a=3 adhere to Best Ha.-�ageme :t Practices
of the approved CE TI-171 N?
7. Does animal waste lagoon have sufficient
freeboard? Sow much? (Approximately )
8. Is the general condition of this CAFO facility,
is eluding managem-ent and operation,
sa,is=actory?
s2:C ION IV
Ccm ents

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �% ' o4-S , 1995
Time: ! ' �
Farm Name/Owner: C 4,e, 6
Mailing Address: H o X `e S lNAtz 5,4 h; 41,f
County: Sampson
Integrator: Carroll Foods Phone:
On Site Representative: Dan LaCoe Phone:
Physical Address/Location:
Type of Operation: Swine JZ
Design Capacity:
DEM Certification Number:
Latitude: "
Poultry Cattle
Number of Animals on Site: /__AA0E!11F4_ AT /Ciz
ACE DEM Certification Number: ACNEW
Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No AVWas
al Freeboard: ' - Ft. Inches
Was any seepage observed from the lag n(s)? Yes or any erosion observed? Yes oz
Is adequate Iand available for spray? tie or No Is a cover,c�%_p adequate? f� or No
Crop(s) being utilized: C A--- r'wIµ'f
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? fe.or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or &'
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or�
Is animal waste discharged into water o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management record (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments: ---
er
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

' JUL 14 '95 11146RM
1
ADRTR CAROLZ' M DEPARTMENT OF ZNV3RQNM=, FZkLTH A NATURAL RPSDURCES
DMSION OF =*=ONIr AL KANAGMCENT
Fayetteville Regional Office
Animal Operation Complia =e Inspection Fora
�� � �s s�cc.
zs
4� •
3 XAILIriGW- DRESS :v,"�:x
—ztY+' k FACILITY ..TFLEF334Hg .:lHnl�P.Ft ::`
P D-NAW et- g56 W ram: 283q 8
ro 3 '- 3434-
All questions answered negatively will be discussed in sufficient detail in
the Comnents Section to enable the deemed Permittee to perform the appropriate
corrections:
OCTION I
.smal 0 eration T
Forses, cattle, sui Poultry, or sheep
SECrrox II
Y I N I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
system)] •
2. Does this facility meet criteria for
Animal Operation RHGISTRAT20x?
3. Are animals confined fed or maintained
in this facility for a 32-month period?
4. Does this facility have a gE TIY= ANII..AL
id TE KArR� r P'L.AI9?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
G. Does this facility meet the SCS mi_Zimtam
setback criteria for neigh-borir_g houses,
wells, etc?

It
y .U1 e,u uu uc.+. vu
��rrzav _zr2
Field Site Manacrement
1. Is animal Waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USCS flap
Blue Lime Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
Q. Does the land application'site have a
cover crap in accordance with the
CERTIFICATION PLAR?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or at -her similar man-made devices?
5. Does the animal waste management at this
farm adhere to Best Management Practices
(WIP) of the approved C�tTIFiaaNl?
7. Does animal waste lagoon have sufficient -
freeboard? How much? (Approximately )
8. Is the general Condition of this CAFO facility,
including management and operation,
satisfactory?
SQGSION TV
Comments
JUL 14 '55 11:46";M

Site Requires Immediate Attention:
Facility No. J2- - M
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7— 2' 1995
Time:
f �
Farm Name/Owner:
Mailing Address: W,5/k Y5,6 W,# z sin/, A/G 3 P/o- -Z 3 � —
County:
Integrator: C /} It 6 //s I—U,-, d 5 Phone:
On Site Representative: 4 CoF Phone:
Physical Address/Location: Ov✓ -#LT V -114f Sle / -
Type of Operation: Swine V Poultry Cattle
Design Capacity: Number of Animals on Site: (X d .SG} i' 1
DEM Certification Number: ACE DEM Certification Number: . LCNEW J—
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hsufficient freeboard of 1 Foot + 5 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: Ft.y Inches
Was any seepage observed from the la (s)? Yes or Was any erosion ob ed? Yes or(gi
es Is adequate land available for spray? r No Is the c ver crop adequate? or No
Crop(s) being utilized: CG -7eu YA.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweliin or No
100 Feet from Wells? � or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or ion
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orb
Is animal waste discharged into water ofAe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or W If Yes, Please Explain.
Does the facility maintain adequate waste management recor s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Lj
FORTH CAROLMA DEPARTMMiT OF F.WIROhY-2-N7, EZALTE & NATURAL RE-'-'OURC'S
DIVISION of Qw"�TTAL
Fayetteville Regional Office
Animal Operation Compliar_ce Iaspec iozn For
C-1 ��
.-'w�II.Ilit"'1�LDDRirSS'•:`•��Y,:"„R,`.��- '•-.• •�.FACiLITY
P.D. K. WABW.
. 2-63 9 s
of 10 -- -2-2 3 -3 4 4-
All. questions answered Negatively will be discussed in sufficient 2etai1 in
the Comments Section to enable the deeded Fermittee to perform the appropriate
corrections:
EE CTION i
imal Operation T
Horses, cattle,9 poultry, o_r sheep
SECTION II
1. Does the nier and type of animal meet or exceed
the (.0217) Criteria? (Cattle (100 head),
horses (75), swine (230), sheep (1,000), and
Poultry (30,000 birds With liquid waste
System) ] •
2. Does this facility meet criteria for
Animal Operation REGISTBATIdH?
3. Are animals confined fed or maintained
in this facility for a 12-month period? .
4. Does this facility have a ANT?ML
WASTE MANAGZMENT FLAK?
5. Does this facility maintain waste management
records (Volu=es of manure, land applied,
spray irrigated on specific acreage with
Specific cover cop)?
6. Does this facility meet the 5CS minimum
se`Uack criteria for neighbcri.ag houses,
wells, etc?
M" • r ~

wUL
CTION III
J� Y N
IL
Field Site
1. Is animal waste stockpiled or lagoon
construction within 100 ft_ o: a BSGS
Map Blue Line Stream?
2. Is ani=al waste land applied or spray
irrigate within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. ]does the land application'sita have a
cover crop in accordance with t}e
=TIPICATZON PLAN?
S. Is animal waste dfscharged into waters of
the state by mz:-made ditch, flushing syste=,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best VAnagement Practices
.. WB ) of the approved gzZTTF1CXTTI9
7. Does animal waste lagoon have suf0cient
freeboard? How much? (Approximately )
8. Is the general condition of this CAFFO facility,
incluWg manage_^.er_t and operation,
satisfactory?
LZ=ION IV

u � u W
\ � -�y J

. w „y - . O �i y `7'. _. �: .0 .4! .
1
14
•

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