820138_INSPECTIONS_20171231

NORTH CAROLINA
a,
Department of Environmental QuA

Type of Visit: k'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: G11outine O Complaint O Follow-up Q Referral 0 Emergency O Other 0 Denied Access
Date of Visit: W Arrival Time: /J Departure Time: County: Region:
Farm Name: T& -I- a//Y! -! Owner Email:
Owner Name: / 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: ; r/ Odd � v Title: _ ���-� s� Phone:
Onsite Representative: �'�_ Integrator:
Certified Operator: �r�.�� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dische 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
• Design Current
❑ NE
Destgn Current
Design Current
., Capaci#y Pop.
Wet Poul#ry � �
Capacity Pop
Cattle Capacity Pop.
o Finish
La
Dai Cow
o Feeder
Ee
Non er
Dai Calf
to Finish
bDlam:
DesignI,Current
Dai Heifer
D Cow
to Wean
to Feeder
tBoars
D . foul
Ca aci ,' P,o
Non -Dai
to Finish
L a ers
Beef Stocker
Non -La ers
Beef Feeder
ullets
Beef Brood Cow
�ETurke
s
Turke Points
Other
Dische 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ 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 0 No [:INA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

IFaciG Number: - Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�jNo DNA ❑ 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?:
❑ Yes
®No
❑ NA
❑ NE
Designed Freeboard (in):
® Yes
❑ No
❑ NA
❑ NE
Observed Freeboard (in): 1-Y
❑ Yes
® No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�1 o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
® No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ELNo
❑ 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
D NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Eg No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�q-No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �g 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): �3 . n ;1l /
oL Q 11-191,
13. Soil Type(s): .ZVtCT —/ f/; )/,--
14. Do the receiving crops differ from those designated in the GAWMP?
❑ Yes
®No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re wired 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
E�J_No
❑ NA'
❑ NE
the appropriate box.
❑ WUP [-]Checklists ❑ Design ❑ Maps p Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
" No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge
Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesED-No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

` Facilitr Number: - l . Date of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:)Yes ® No ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Z, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Pq No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[&No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ANo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
h7'
bT r' D71
Reviewer/Inspector Name: 152
Reviewer/Inspector Signature:
Phone: 57;w
Date: /_:-� it -J
Page 3 of 3 2/4/2015

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: , 3D Departure Time: , Dd County: �,o —Region:
Farm Name:.� �� //rrS `j G, Owner Email:
Owner Name: j,,,� a-, Phone:
Mailing Address:
Physical Address:
Facility Contact: 1_; e1,tjp 11 S Pte-- Title: Phone:
Onsite Representative: Cj Integrator: �jyl f /
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
❑ NE
❑ Yes
Dairy Calf
Feeder to Finish
❑ NE
Dairy Heifer
Farrow to WeanDesign
Current
Dry Cow
Farrow to Feeder
D , P,ouI
Ca act
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
[DYes MNo ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes
❑No
❑ NA
❑ NE
❑ Yes
;allo
❑ NA
❑ NE
❑ Yes
EjNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

[Facility Number: Date of Inspection: — 1
Waste Collection & Treatment
. 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): y j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a [:]Yes allo ❑ 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 20 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�g_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): -t- Uv
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? fo Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Rem( uired 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
❑ Yes ® No
❑ Yes No
® Yes ❑ No
EJWUP ❑Checklists CDDesign ❑ Maps ❑ Lease Agreements ❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. [Z Yes [] No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;-.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
❑NA []NE
Page 2 of 3 1/4/2015 Continued

)<acifi Number: _ Date of inspection:dV
%.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes .] No ❑ NA ❑ NE
1.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No [DNA ❑ 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 10 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes n No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
❑ Yes
[A No ❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
.'
yExplatn
xr
�'l�omments � . �
iiOS Oi•�A1.1�7tV to hPtfPY PYfilAlfl C7tianti tIC'��1CP'.AiIE�ItiAtlAt4T1AOPR
!+
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
fA No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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 CA WMT?
❑ Yes
® No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[A No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
{Yes
[:]No ❑ NA
❑ NE
any YES answes tin/ aonaor, any other comments.,
(refer to questi�o�n#) dor,anydditil recommendations
SCE€EI,
.'
yExplatn
xr
�'l�omments � . �
iiOS Oi•�A1.1�7tV to hPtfPY PYfilAlfl C7tianti tIC'��1CP'.AiIE�ItiAtlAt4T1AOPR
!+
�v /
Asa
7
3q 7- --F
Reviewer/Inspector Name: STCtc_
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:3F�f�
21412015

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Linwood Eason
32 Eason -Elmore Road
Dunn, NC 28334
Dear Mr. Eason,
e��
DEHNR
DIVISION OF WATER QUALITY
July 15, 1996
SUBJECT: Eason Swine Farm
Reg. # 82-138
Sampson Co.
On 7/10/96 staff from the Fayetteville Regional Office of the
Division of Water Quality inspected your animal operation and the
lagoon(s) serving this operation. It was observed that the
existing lagoons did not have the sufficient freeboard of one foot
and seven inches for the 25 year 24 hour storm event and the small
lagoon was overtopping. The overtopping of the small lagoon
allowed waste water to flow into a low, wet area directly adjacent
to the lagoon. In addition, waste was observed leaking out of the
last house nearest to a cleared wet area at a steady and continuous
flow. This discharge allowed waste to drain into a recently
cleared wet area where the waste entered a ponded section of the
property. These discharges were not observed to have discharged to
the surface waters of the State at the time of inspection. Please
be advised that had this Office observed any waste from these
events in the surface waters of the site, we would be recommending
a civil penalty be assessed against this farm immediately_
In order to properly correct the deficiencies listed above, it
is required that the lagoon levels should be lowered immediately
via the spray application of waste material. In addition, the leak
from the last swine house needs to be repaired immediately to avoid
any further discharge.
Furthermore, to remain a deemed permitted facility, a
Certified Waste Management Plan for your farm must be received by
this office within 60 days of receipt of this letter. Failure to
do so may result in the facility losing it's deemed permitted
status and being required to obtain an individual non -discharge
permit for the facility.
Wachovia Building, Suite 714, Fayetteville ���� FAX [phone]
North Carolina 28301-5043 N fr An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/ 10% post -consumer paper

1*
Mr. Eason
Page 2
7/12/96
Please be aware it is a violation of North Carolina General
Statutes to discharge waste water to the surface waters of the
State without a permit. The Division of Water Quality has the
authority to levy a civil penalty of not more than $10,000.00 per
day per violation.
When the required corrective actions are complete, please
notify this office in writing at the address below. If you have
any questions concerning this matter, please call Ed Buchan or
Michael Wicker at [phone].
Wachovia Bldg.
Suite 714
Fayetteville,
NC 28301-5043
Sincerely,
Ed Buchan
Environmental Engineer
cc:
Chris Walling - Soil and Water Conservation (Fayetteville)
Wilson Spencer - NRCS Sampson County (Clinton)
Dianne Wilburn - DWQ Facility Compliance (Raleigh)

ractury ivamoer.}��. �
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Dam: 31to
Time, 10: 00
General •
Fkrm
O VW Name: L i n L-,3nc,>d Fa S -n n _ done No: $% 3
On Site Representative: '�`—,Integrator. e r l -1,4e
MailingAddress: Clr,ore fid
�b t 046 rJ Cr 7J3 3 3`t
Physical
• Latitude: 351 i 1 a 7 Longitude:
Operation Description: (based on desip characteristics)
7 Sow swine No. of Annemab O Pyof�P0drry Nc. of Anima;U O p No. of MimaU
airy
O N�_ur�soy ,,'tt' - O Non-L.sym G Beef
13 Re�-
Otwerr =` Number of Animals: DDD s.
Numbef of Lagoons: (include in the Drawings and Observations the frxboard of each Imoaa)
Lagoon
Is `Iagoon(s) freeboard less than I•foot + 25 year 24 hour storm storage?: Yes No 0
U,seepage observed from the lagoon?: Yes 0(No ❑
LSSerosion observed?: Yes,02r-'No O
s any discharge observed?/ Yes Er No 0
t
,C Man-made Nos Man-made C ��
Cover Crop
Does the facility need more acreage for spraying?: � es O N0101 -
Does the cover crop need improvement?: Yes
( list the crops which need LVrove sent)
Crop type:.
Setback Criteria
Is a dwelling located within 200 feet of waste application? O D
Is a weU located within 100 feet of waste application? O
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes 0 No O
.Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? Yes 0 NoX
A01- Janaary 17,2996

Mawenance
Does the facility maintenance need imprvvr.meat? Ye :Mz No O
Is there evidence of past discharge from any part of the operation? Yes`
Does record keeping need improvement? YO LO N
Did the facility fail to have a copy of the Animal Waste Management Plan on ate? Yes O No O
Explain any
Yeas answers• S r
TT�r` 4 c on + r ren �b 2 J• e �fp t+
rr 1 f
r ow `�r � l �_ I
OD C. GAS Kr o �' T Cr
"`IsQ.t fn
r ` `
rSl Date: jO
e= Fft-Mry Asses=IM Unit Use Attachments Y Vea a
Drawings or ObseryutioM:
Go{to+1 �s2.i�
Eks eo1
Ef�art Cr_
Kaa.�
I"',
Pa
_ wa__c
- SwW»P/Gu�oYe r ___ , _ —
i.. l��•, '�J �t - __. . nr.t7''.ti. - ��'... �. Baa- X114' ►r.�.p *.we<•Mr"+"'.r•`.i .T�� ��:_
at li:- i r� . •Y r.r�.�:ni-^ »1-�.•- '+. •,�.J •�(`i �:-'1. 4�.r-..�.���r. n �,
AOI— Janu=717,19%

Type of Visit 0 -Compliance Inspection ()Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Routine Q Complaint 0 Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: ® :SaM Region:
g� iV D Arrival Time: � Departure Time: 1; � �� Connty
Farm Name: DA r&M Owner Email:
Owner Name: _ LaA vv j_ Phone: qq►
Mailing Address: — tY 1)✓n!) ap
Physical Address:
Facility Contact:
Title: Phone No:
a
Onsite Representative: Ll
Certified Operator: Ug iocd
Back-up Operator:
Integrator:
Operator Certification Number: 1 83
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = u Longitude: =0=.
0=. = 6i
©e°stgn Current iP
Swine ''N eit} Populat�ogn
❑ Wean to Finish
pDe g @urrent
Wet Poultry Capacity l opulat#on
❑ La er
Cattle
❑Dai Cow
Design Current
Capacity Papulation
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish'��r
❑Dairy Heifer
❑ Yes
❑ Farrow to Wean_+
Dry Poultry
���`�. .
El Dry Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Farrow to Feeder
ti_
="` _`"
❑ Non -Dairy
❑ NE
❑ Farrow to Finish
❑ La ers .
❑ Beef Stocker
❑ Gilts
❑Nan -La ers
❑ Beef Feeder
❑ No
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Yes
CR No
❑ Turkeys
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other. o
El Turkey Poults
❑ NA
❑ NE
Other
❑ Other
Number of Structures:
Page 1 of 3
12/28/04
Diseharees & 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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CR No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
29 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

..
O
Facility Number: 16 — Date of Inspection ® Cdie
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? skyes [RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U No
❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo
[INA ❑ 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?
Rolfes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C'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
ff 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
15� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or l0 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) ' vQ NAO, .S G og
13. Soil type(s) A✓t Ig
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t8 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ NA ❑ NE
Reviewer/lnspector Name C ;WfPGjn= Phone:LL33-330OX 3M
Reviewer/Inspector Signature: &A Date: aw
Page 2 of 3 12/28/04 Continued

4
Facility Number: a — Date of Inspection UnIxila
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®'No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
tikNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Eallo
❑ 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
'S No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�!; No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
['Yes
WNo
❑ NA
❑ NE
.Additional Comments and'!or 1]r�wmgs.
adct- peso' 1, sem( 4.mvlch inside- I7=006, .ham s
uff �I`
Pifise cut 4an 4oo-C bortk� Poljon rkm on
1s, pjann i -10 l ime- ned we-ek
Vi - w Me4er Iv Ciel d Ofcai, �r �no
h r aP� l� �
a5, Mill nM -Stud ye, Svry-e
a � Psbe_ kf>pe fvgi� Owl Se w i� o�� recad.�
br �n &4P aooq 01 1100 � C&,,e,'
�v$
P)9 hs -3p1 Ore I� oo - sA¢llf,
C-xemaw'y nNeS r)0+ On -6�1m
�,lssd� 6f jajw rvarCaved a-�-�� r� h�1 s �` �►►�y b�h
Page 3 of 3 12128/04

Facility No. f —13g Fame Name Li�lwDac( �—v)41 Date )01a) lox
Permit ✓ COC al� OIC NPDES (Rain breaker PLAT Annual Cert )
Pop.Type Design Current FB Drops
SPC—
' r
Freeboard 1 2 3 4 5 6 7
Design.
BIMS
Observed in S
Sludge Survey Date Perm Liquid ft
5lud a Depth ft
I '^.-Rft ,on �A— wha, cAAM
Calibration Date 1 2 3 4 5 6 7 8.
Design Flow
Actual Flow r
Design Width
Actual Width
Rainfall >1"r`J
1 in Inspections
'120 min Inspections
Transfer Sheets
Soil Test 51dd-k Wettable Acres
pH Fields �pH Lagoon_ �gj Crop Yield
Lime Needed rkh4 Rain Gauge
Cu Weekly Freeboard
Zn
A..o
07-14 MM
.r r_
M.
71
Pull/Field Soil Crop ari YVindow
M t --Mill- w
50? F'
RQ�

�w U
a=3
Peador 10YoU
y Ja P�o
So lid( Feve e o- - y`s d -v -
acel6 dtq%*j
b;ayoiV)o4el � � `4°f ° ~
j„,z-yhkah :.
8joafQtfV .) n-, Pe4 -
lae
�►o��ea3 -sad rC-
VS
- a h�OSb-
P'+�►o-`P.Dits 3o Gly
awob a
�0°J0
W0f
q, 3 AL
WiRoal�aL

NW-,e(5-
for
W-,els
-d3trD
for Visit: 0icoutine O Complaint O Follow-up O Referral O
U Technical Assistance
O Other O Denied Access
Date of Visit:
_1 Arrival Time:
Departure Time: : 3
County: f�i�sp-`
/V
� Region:
Farm Name: Jry
Wet Poaltry
Owner Email:
Pop.
Cattle Capacity Pop.
Owner Name: _�5�.�,,�,snG• Phone:
Mailing Address:
Physical Address:
Facility Contact: ,!>��.`r� �upg� �A �_ Title: Phone:
Onsite Representative: ND -A, Integrator:
Certified Operator: L -,-,-z wood U— Certification Number: / 7�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poaltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[]Yes
I
ILayer
I
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
ai Cow
Wean to Feeder
❑ NE
I
iNon-Layer
I
ai Calf
Feeder to Finish
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Dairy Heifer
Farrow to Wean
❑ NA
❑ NE
Design
Current
Dry Cow
Farrow to Feeder
❑ NE
D , P,oul
Ga acit
Po
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmpacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
allo
❑ 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 1 of 3 2/411014 Continued

Facili Number: - Date of Inspection: / y ,AC7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ZI 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 [DNA ❑ 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? ayes 045ro ❑ NA ❑ NE
8. Do any of the structures 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 ES No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 10 No [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes Egl-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E] Evidence
/off Wind Drift ❑,9 Application Outside of Approved Area
12. Crop Type(s): —
13. Soil Type(s): / v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E 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
ELNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ 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. E2�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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ffj No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J.No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

` Facility Number: - 13 1 Date of Ins ection: Z=2 t4-15-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
g Yes
❑ No ❑ NA CINE
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EA No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VI No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J4 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
RNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yesjrg'o'�
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency'?
M—Yes
❑ No ❑ NA ❑ NE
7
Nit
3 d-3 t 171111
3 �
t�{�1 crrtS /7
p2 1 f I✓U G U ✓ rr (i(%5 fiY 417- r4 --f
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phon
Dat)bZ/a-L/�`�33
21412017

0
of Visit: O"Compliance Inspection 0 Operation Review 0 Structure
in for Visit: a, routine 0 Complaint 0 Follow-up 0 Referral 0
-9-/410VAI
0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 3D County:
Farm Name: �ar S _T�� C . Owner Email:
Owner Name: Z7,;,5 &, fir c, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,Q�,L//�* / Phone:
Onsite Representative: f Integrator: m
Certified Operator: �s� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: fl< O
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 a No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
Design �Muult
DNA
Design
Current
Designurrent
❑ NA
[:1 NE
ry
Capacity
Pop.
CattEe Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
`fiivD
Dai Heifer
Farrow to Wean
Design
Curr_eat":
D Cow
Farrow to Feeder
D . _ P,oult .
Ca ad
P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 a No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
0 N
DNA
El NE
❑ Yes
� No
❑ NA
[:1 NE
❑ Yes
N No
❑ NA
❑ NE
Page I of 3 214/2011 Continued

• Facility Number: _ 3 1- Date of Inspection: Lj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): AL
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 4Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
1 L is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZ No
❑ NA
❑ NE
[❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > LO% 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): ��!`/yL �i � -rd� /%� �� / S 6 zra-S MW2 G /vl
i
13. Soil Type(s): r Yvdj.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0- No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [4 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes RNo
❑ 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 [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

FaciliNumber: - Date of Inspection:F—IV-191
y 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S 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 (ZL No
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�L 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 ®, No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No [DNA ❑ NE
❑ Yes S No
❑ Yes' ® No
[—]Yes [Z No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to questions
.#): Explain.any YES answers and/or any additional recommendations or any other comment
Use drawings of facility to better:explain situations (use additional pages as necessary).
Reviewer/Inspector Name.
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2017

n.anr --I-, J.- .t.I
VrMl V V-3 1111113
• Division of Wat r Qaality
Facility Number ®- )3g O Division of Soil and Water Conservation
0 Other gsncyffl
y
Type of Visit: GrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: la Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 Arrival Time: Departure Time: : County
Farm Name: Eajo, r Owner Email:
Owner Name: L11A how PQ1Q Phone:
Mailing Address:
Physical Address:
Region: Fisc Q
n ��``�
Facility Contact: VV E(1 Title: 10 wi)?/ Phone:
Onsite Representative: Integrator: H-0
Certified Operator: 4aww FCertification Number: �g37Y
;tk-e•T�Ji+
Back-up Operator: f&, Certification Number: )g373
Location of Farm:
Latitude:
Longitude:
Design Current
DesignEurrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacit- --
yPop.
Cattle Capacity Pop.
Wean to Finish
Layer
Daig Cow
Wean to Feeder
Non -La er
I
Daja Calf
X Feeder to Finish
"- ` -
Heifer
Farrow to Wean
—Dairy
Dry Cow
Farrow to Feeder
D . P,out
Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 (2 No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
[:]Yes ❑ No
[—]Yes ® No
[-]Yes ® No
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 1,0131
❑ Yes
[2 No
0 NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
15a No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
W No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
to No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir S tal threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Y
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�g 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
N Tio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
0 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
ceN
12. Crop Type(s): li-1 jB&A46L I SM)I Q!Q�. -
13. Soil Type(s): t/ V It ,B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2 No
0 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
0 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
15a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
W No
❑ NA
0 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 p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
® NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: jDate of Inspection:
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:
NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CR No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [2 NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
No
❑ NA
D NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
fo No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[X No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations oranyAother comments` ti
k;p3'
Use drawings of facility to better explain situations (use additional pages as necessary).
7Ple4,e_ do more rmow,h o� bac�rl'de_ of la oal but �s, r � lu c -V Of pairol c
b 7r m A Ja k dow, *eer ��
Rade o `F pro mRd .
-�er✓ Pokeweedr � f� � ks �
O(e cl03e_ '1P ia9 b4aM ,
A$ -4j& ry a.r r win ai -tne of j (qedjr woi ee
Reviewer/Inspector Name: ZrOdA S
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — 33—ZO00 Etf)
Date: 3
2/412011

. Facility.No. SDI 3S Farm Name GcnhoA Egial __-_ Date
Permit +� COC .oi�g��� OIC✓ N PDES (Rain breaker PLAT
Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 2 3 4 5 16 7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt- Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date 1 2 3 4 5 6 7 a
Ring Size in
Design Flow m
Actual Flow
Design Diam. ft
Actual Diam.
Soil Test Date i
y11?
Crop Yield ✓
Transfer Sheets
pH Fields b,�
, r-21'
,
Wettable Acres
RAIN GAUGE
Lime Needed �^
�0�#a
WUP ✓
Dead box or incinerator
Lime Applied
✓
Weekly Freeboard
Mortality Records
Cu -1 Zn -I ✓
1 in Inspections
Chk Lists
Needs S (S-1<25) _�„�
120 min Insp.
St:m Water
Needs P n
WPathPr C nrJPc
LT AIT M- In, -Tviv.11 NMI 0.11M �Wmfhv
111 _
✓n C rYdX-JrA1 if Ll Y L r mlaru uw,r " T "" w u[ �rry���K dwa �w ., outs �+(wrvrur� �.�✓
Pull/Field Soil ro Acres PAN I Window .4Max Rate Max Amt
,ri I I P ILU. •C,,- 1.... l— ft l__ nom-. r -.L .e
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm qQ Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3 t,
08 lb/ac; Zn -I 3000 213 Ib/ac

type or visit: q7�Lompuance tnspecnon L,j tiperatton meview V structure Evaivanon V tecnnicarAssistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L`?1l,A!_ Arrival Time: Departure Time: ;dp County:
Farm Name: Arm Owner Email:
Owner Name: Utwon t Fa (ch Phone:
Mailing Address:
Physical Address:
Region: F M
Facility Contact: I jAW00k le ajpn Title: 0Wl-�llPhone:
Onsite Representative: nvNufm Integrator: H—B
Certified Operator: Lrn h'@)pcL Fa303 Certification Number:
183�Y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
CurrentDe
Pop.
g Current
Wet Poultry�R"MCapacttySPkop.
La er
Design Current
Cattle Capacity Pop.
DakCow
Wean to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
Non -La er
Da Calf
Feeder to Finish.
3000
�za '
Dairy Heifer
'H60
Farrow to Wean
❑ NA
DesignKCurrent
Dry Cow
Farrow to Feeder
KI No
Dr v P,oult . '-Ca 'ci
Non -Dairy
Farrow to Finish
❑ Yes
Layers
Beef Stocker
Gilts
of the State other than from a discharge?
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes R7No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[:]Yes
❑No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
KI No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the watcrs
❑ Yes
ETNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facility,Numher: $ - Date of Inspection: _qjj all=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier -
Spillway?: dentitier-
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.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes tg No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 151 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? J>_� 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes r5a-No [DNA ❑ 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 i 0 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): L
13. Soil Type(s): v1 `r pi
14. Do the receiving crops Iffier from those designated in the CAWMP?
❑ Yes
1�2 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
[,2 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5j -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[>_�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CS�NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: a:4, - 11r Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
aYes
❑ No
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
fR No
❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[-]Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
CR No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
ER --No
26. Did the facility fail provide documentation of an actively certified operator in charge?
[-]Yes
ITCNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[2[ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes R No ❑ NA ❑ NE
and report mortality rates that were higher than normal? `
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [5jNo ❑ 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 P No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
5R�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[-]Yes
f5it No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
CR No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
ER --No
❑ NA
❑ NE
- . Pleoje work of (aye bare Set sow mf r1raik e ffs, rvf I nem 100fw-) /) j, jvp '
4n� afar
Is n0t1'1�efiatjf (JVs)
C he(k o. n`P ad -ak s&l-'� ar+' mf- ro; j 4e[� a Lr"me � l e"els oreywd
a4. Pl,eafe ha�� loh-m-call'ba CFfDdvw wiclewar�r lit '60.
a S a CVM`h_f- s1 udye_,s vve v ieweweDSI. please a'o 1% e fn @01.3,
ROtm ,(br 64Tol[ fril-nwal
f�r rr, rs (a e9 AIW AIWr'edc eke-17inr +P wa1
%� Y�y1Pl �e 'dr'c fad ��dd �
Vrrb f &_ s e ai 41.
Sl v49e hlar edtAedo� 6-fyea- ard- twlmi-cA s f10yib Yva,rdche_,,,` cethe,.
ReviewertInspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gr0-g33-3_v I11I ke)
Date: S Q a7
2/4/2011

' raciiity
No!3a-139"
Farm Name L(n E --:,q) ,
Datel la 10,
Permit
COC
OIC_
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe }
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in 3
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
r�+sryi r.1 W
Actual Flow
Soil Test Date[
Crop Yield
Transfer Sheetsn c
pH Fields
Wettable Acres
i
RAIN GAUGE
Lime NeededWUP
✓
t-4�e/ Dead box or incinerator
Lime Applied
Weekly Freeboard
✓
Mortality Records
Cu -I L,Zn-I v
1 in Inspections
Check Lists
Needs S (S-1<25)120
vo
min Insp.
Storm Water
Needs P
Weather Codes
Waste Date
- 60 Da
+ 60 Da
N (Ib/1000 Gal) �A q1
!C 6 1 Wfflwli=�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Iblac; Zn -I 3000= 213 Ib/ac

ec ( 65,;
�b� c f f4 hh�
p1b _shf
-a It
V60, 000
rntco
�(tic
tile
rntco

� rhe �y� -�rrdlll
-.
'
h�aDivir
sion of Water'Qual>ty= -
Facility Number ® (3$ ©Division of Soil and Water Conservation
r_
©Other Agency
Type of Visit: 10 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ID Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time: Departure Time: .+-lT County:yfQ�
Farm Name_ tUj&) F&M �� Owner Email:
Owner Name: L- w012d Phone:
a
Mailing Address:
Physical Address:
Region: FAA --
Facility Contact: -i IV wto no Title: 01r11or Phone:
Onsite Representative: Integrator: fl—[3
Certified Operator: r Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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 DWQ)
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c- What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? {If yes, notify DWQ} ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3- Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued
Design Current
Design @unt_
01 Design Current
Swine
Capacity 'Pop.
Wet Poultry
Gapactty Pop
C►attle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder
Nan -La er
W
Dairy Calf
to Finish
Dai Heifer
Dry Cow
Farrow to Wean Desig
Farrow to Feeder
Dr, Poul_ .
Ca PAc1ty .Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
I Fit,,--
Other
Turkey Poults
Other
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 DWQ)
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c- What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? {If yes, notify DWQ} ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3- Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

Facility Number: -13 Date of Ins ection:
❑ Yes
CR No
❑ NA
❑ NE
Waste Collection & Treatment
Ig Yes
❑ No
0 NA
❑ NE
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
❑ NE
Identifier:
❑ Yes
No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):_
❑ Yes
No
❑ NA
❑ NE
Observed Freeboard (in): 2ZI^
❑ Yes
No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fg 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?
JZ 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
CD No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_
❑ Yes
allo
❑ 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, Soii Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Ig Yes
❑ No
0 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 [R 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 1�] 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 E] NE
® NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes N] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail.to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑Yes No ❑N ❑NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes t@ No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JMNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�jj No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fRNo
❑ NA
❑ NE
Comments (refer Explain any YES answers and/or
any recommendationsr ,
m
pages asnecessay)•additonalUse. drawings facility. beer explain situations (use
;
_
p work on bore s t} ol) io Ju9�-i �n f s� c t°.an��cim back b�h�J4
�e a•efa /i ori b � wof klli 1
�.
34, Pkt huye� 1oNme+l- ea 1" b'a4&d_ )+ 's v��� ip _t,(Ock Q.e/'wZarb/
off l�a�-#
s h - d.oLto`68� s UAWSl _
a5t SJtd e �a � � � s�e�, ��~s �-, girl 61)
a•d o , A bo�- g yo ooa qa l l9,,s Iva r se 0 JAS �b oft (UVJ ver a ��fi j 4 y c. tNwo �'h e faj�r�i
Yvas chetked- ahL a drive ale 0) ff /"Cd_� 4b fields -Poi pe Cry
onctS•
Cove�oje( mosil co n�� 21N�ri�v;nvni--o,� r+zQji, fac}S,
16 c4r��tC-;rf�rcrrl��_ �i1�I11J
Forfi 1`S j m rovek Sin (e- l a3 � 8 � Aoj n F ao
��xel�, noks abo�, ,not O�fur n� C $r �.
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
OYA 5 r Phone: 9i p -y33_ W3
Date:
2/4/2011

. Facility No3a-
OT
Farm Name LI A V►-06ct- E 6T0n
Date q 1 o o
Permit X
COC
`� OIC
NPDES (Rain breaker PLAT Annual Cert )
FB
Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 0471 (P
Sludge Depth ft
-Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
CZZl'�i1 .1F►TalCi
Calibration Dat�
SIMES lima l• --------
Soil Test Date 7 I
Wettable Acres ✓ RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed 3
Lime AppliedTo—�e�h�h �Ir
Weekly Freeboard Mortality Records
1 in Inspections f
Cu -1 tl Zn -I ��
120 min Insp.
Needs P
Weather Codes ✓
CroD Yield
Transfer Sheets
Waste—Analysis Date
rr� _
Pulffield Soil Crop Acres PAN Window Max Rate Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records Nat D r C
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 Iblac
i -VC
back 'If �0

�1 �J- u, ur a CTT
n
UT
o
�
�.L c -f
v
c�
c�
f
s�
<�!
UT
o
�
�.L c -f
v
c�
s�
k, A
o
�
�.L c -f
s�
Z � qu
s �
n o �.
T � � � a
o � �
coo
�.L c -f
f
Z � qu
s �
n o �.
T � � � a
o � �
coo

DINS ;J -vs
D rko
Type of Visit (23CCompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: QQ,00 Departure Time: ,rt County: ori Region: Eft
Farm Name: t:;A) C _ Owner Email:
OwnerName: I _ inn i -I' Ale 4J on Phone:
Mailing Address:
Physical Address
Facility Contact: LV_ltL Lose) Title: 0�'4-0--.,, .. Phone No:
Onsite Representative: i_[►�"04 0' kn b LOS61 Integrator: � [ `B
Certified Operator: Lin wood- E0sa) Operator Certification Number: c�37�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=0
0' ❑ Longitude: ❑ ° = I ❑ "
Design •urrent
Swine C►apacity Population
Desimnc.enturr
Wet Poultry pulation
Design Current
Cattle Capacity Population
❑ NE
❑ Wean to Finish
❑ Layer
❑ NA
❑ NE
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
ceder to Finish
❑ Yes
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
❑ Non -Dairy I
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Gilts
Non -Layers ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑Turkeys
Other
❑ Turke Poults
❑ Other
❑ Other I
Number of Structures:
Discharges & Stream lmpacts
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 [R -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: %31,— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _ 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 15iNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5, Structure 6
❑ Yes M:No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 1B Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA EINE
(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 ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apl2lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 19 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O 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 typeL[ %s) aif QP
�j
/M ULP Q iia V '.Smo)) ky Jg u 5 P --
13. Soil type(s)
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fg No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
23 No
❑ NA
❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CKNo
❑ NA
❑ NE
Comments,( refer to question #): Explain any YES answers and/or•any recommendations or any other comments.
better ex Iain situat,ons. (use additional;
Use drawings of faci$to ty p gages as necessary. ):
Ak
q cOg_Na Cc
Reviewer/InspectorName '� ,, SC>f�rlV(E� Phone: Q 0 433-333:3
Reviewer/Inspector Signature: Date:
Pulte 2 of 3 12128/04 Continued

E
Facility Number: a -- Date of Inspection �[
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes �j 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 [ANo ❑ 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
MNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
f�[NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
J.Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
9 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
IR 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
ftyeslNo
❑ 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
�TNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
07yes
❑ No
❑ NA
❑ NE
AdtlitianaI Comments and/or Drawings:
Qu.1hPS Srnailarefel +rinm ba��o��yy°A. VA,a� pCv
(0�s pVA u Qlf Yva-k ? bb; S �1 -for
L' ed: I l acres ev s um m -r ,
��x� sa s,�- �rrrar n��k m®s�
After noin�cr� in mno�.o -tPult"'r)
L' M -c� yr garb o �#-, ��f*W04 os not bnA 177,91141,
ate
a�, Div �}7 P1 1S U1� OCe� S SIjIS o-Fa?jrbra��'J
ud S1Jrv� �0 f will n� cqe b,d aolo
33, Fdowup Chi en a ' .
VeIMI- rvAs D 'r1n cLi/l �a , - pea, � � p � n e,� a,,e_ AEAA
�brtoy ao/Q, moV�o be isgc"41
Pugs 3 of 3 12/28/04

P05 0-f HNII/
Facility NoSa'1.-33- Farm Name L1�0-00 Date ba {D
Permit COC OIC_ NPDES {Rain breaker PLAT Annual Cert }
Pop. Design Current FB
Type Dro s
{
kokq
I
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft r
Ratio Sludge to Treatment Volume
L ;Mf
Calibration Date 1 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date Jc �f y t Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed lei Wr3 tV'��'.—Weekly Freeboard v Mortality Records
Lime Applied Yfj-F�rxl a �1 in Inspections —
Cu -I ____VZn-I 120 min Insp.
Needs P N 0 Weather Codes c_—
Crop Yield Transfer Sheets h IDt`
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
r) --F;-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO c10 ,V- Q3 Date last WUP at farm -a1
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Iblac; Zn -I 3000= 213 lblac
App. Hardware
. _ WiF3'111! to t� �Miri'
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
r) --F;-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO c10 ,V- Q3 Date last WUP at farm -a1
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Iblac; Zn -I 3000= 213 lblac
App. Hardware

0q
� �W
OC
�tlld"�5,
l
ZC
ge Ie I O)
}, e I ��
L
7C,_ L)
-cc
01
'CC
q
,ct
A�jh
I)�h
v) c
0/1 C -e) —$)_e) �� Ve 7 t ())'N
01
�-L
l�opejra P r/ a(: `

Type of Visit "8 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
15
Date of Visit: Arrival Time: Departure Time: f 1 County: J .lr Region: _
Farm Name: �ir�l�_.. _ Owner Email:
1
Owner Name: Phone:
Mailing Address: 3a M&, - elma2 unn a$ 3 3 V
Physical Address:
R
Facility Contact: womt t�OJQ2 Title: �%y/1{�` Phone No:
Onsite Representative: C�
Certified Operator: L1n
Back-up Operator:
Integrator:
Operator Certification Number: AwA _ f �
Back-up Certification Number:
Location of Farm: Latitude: =' =' = Longitude: [_—] ° ❑ ' =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apaeity Population
❑ Wean to Finish
❑ I a er
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
❑ NA
9Feeder to Finish
❑ Dairy Heifer
❑ No
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ NE
❑ Gilts
on -Layers
❑Beef Feeder
❑ NA
El Boars
❑ Pullets
❑ Beef Brood Cow
10 No
❑ NA
ElTurkeys
other than from a discharge?
Other
❑ Other
❑ Turkey Poults
❑ Other T
Number of Structures:
12/28/04
Continued
Discharses & 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
❑ 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
'UNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
10 No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: g a — I3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA EINE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -1
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CBNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes JNo ❑ 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 allo ❑ NA EINE
(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 UNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CR -No ❑ NA ❑ NE
maintenance/improvement?
H. . Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes E�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) Q0 aila i 15&m td.4 - t zL(u S G
13. Soil type(s) Autryw 11ie- Is
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IgNo
❑ NA
❑ NE
Comments (refer to question'#) Explain any YES answers and/or any; recommen ations or,any othe_ri.camments. LL
Use drawings of facility to better explain situations: (use additional pages as i&essary) u�
Reviewer/Inspector Name ��)
e Phone
Reviewer/Inspector Signature: _ � Q,(p� Date: A14
Continued

136
Facility Numl Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t;�'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [I Design ❑Maps ❑ Other
A ' ❑ No ❑ NA [:1 NE
21. Does record keeping need improvement? If yes, check the appropriate box below. 'Yes
❑ Waste Application ❑ Weekly Freeboard 19 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield IR120 Minute Inspections ❑ Monthly and V Rain Inspections 'Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ERNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No aNA EINE
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
ERNo
[I A
ElNE
26. Did the facility fail to have an actively certified operator in charge?
p
❑ Yes
E9 No
i NA
E]NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(SNA
❑ NE
Other Issues
04*,e&-r o Mia- - o �� � 47
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fgNo
❑ 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
kNo
❑ 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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
RYes
o
❑ NA
❑ NE
Addfiid"V!P- n en's andlor Draw
%je CL4 bock_ �j 4-bvjh:°� more- On bacitside o l ��: I'�Uch r (40v
S �nc-P k ao-V � -e ar , A ts p s ePk)+o so i i a m v1ch bA c4G om r� of far, ban d
Onve-ko�, at re 1i me- n Aeri 1� e..% -so I L 4eit
Ne#,oe, mai pT#a� [y -+a FaYeNP�; jlt Of2e(e_
I)Wa-AO wo�� 'Ana�xf
Fay,e�,,,Ile �yi�,al RealI4f,Pebard /Iellod
a_a s c s -f, svi'� `71 S >^flr�ds
O`j�{ev�lle AJC a$30jo�gl{� 1Pct�d�
*d_ IRA WIWC 164
1ef#e rbi) �ccral�S,
N -tv
41aP , a low, /
W, o ca lI 6a 4� 1 A 4 itP
Main 0f?-*/- not Yw ki� h lw "��ssem, , hall do 'o�Jor� �� ""-V fio-,
04*,e&-r o Mia- - o �� � 47
12/28/04

• -Facility No. g Farm Name L;1 f`a Date
h*
Permit �� COC ^� OIC_ NPDES (Rainbreaker PLAT Annual Cert )
U. PAW Am
=—
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date a57
Sludge Depth ft & %
Liquid Trt. Zone ft ,
Calibration Date
Soil Test Date&
pH Fields
Lime Needed
Lime Applied ,g�—�`[`C��oIC/�
Cu ✓ Zn
Needs P _1
Crop Yield L%
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections ---
Waste A
-
-' D_- ►D Lffi� G�
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
Q/—
�� S l
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump

7
_ Division of Water Quality
[Facility Number5a�—EMJ O Division of Soil and Water Conservation i4zj
�oil O Other Agency
Type of Visit 19 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: tMV-)
Arrival Time: Departure Time: County: i Region: o
Farm Name: rai m Owner Email:
Owner Name: 1 ��S�Y7 Phone:
Mailing Address:
Physical Address:
Facility Contact: C trl4][J, 1 Title:
"Phone No:
Onsite Representative: Integrator:
Certified Operator: L•+ Y) L^3 S Operator Certification Number:
Back-up Operator -
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back -up Certification Number:
Latitude: =0 =s
=is Longitude: ❑ 0 =I = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La ye
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes; notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t No ❑ NA ❑ NE
❑ Yes
❑ No [ANA
❑ NE
❑ Yes
❑ No jXbNA
❑ NE
El Yes
❑No4NA
ONE
❑ Yes
9No ❑ NA
❑ NE
❑ Yes
❑ No 19)NA
❑ NE
12/28/04 Continued

FacilityNumber: � — 13j
Date of Inspection 1 ?
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes )5 No ❑ NA ❑ NE
StructA I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes *o ❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes *o ❑ 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? )KYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes No
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes IkNo
El Excessive Ponding F-1HydraulicOverload El Frozen Ground Ll 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)
0
❑ NA ❑ NE
El NA 0 N
13. Soil type(s) A V1_
mtd 4-cro'l7woll rhe
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
*0 .: ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?[] Yes
�No
[jNA
[INE
17. Does the facitity lack adequate acreage for land application?
ElYes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
mtd 4-cro'l7woll rhe
Reviewer/Inspector Name G Phone:
Reviewer/Inspector Signature: n Date:
12/18104 Continued

Facility NumberZ Date of Inspectione7
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes VNo
l&No
ElNA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
D ti/J Q.
2-ZG- Cq fc
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes gNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
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 AVNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes oNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes %No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
)aNA[INE
Other Issues
1111
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes JV1No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes MNo
❑ 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 P 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 �rNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
- �I O� �>.�S�2Xrt
•
4Jtnt� lFrabo5_r cL [Ar ds
L
n
-- S-�-a[�C � ,Z � ► ' f GY�E'�-�� ` `'+ K -P CII-tr 'S
51so
D ti/J Q.
2-ZG- Cq fc
o�H e v
U
12/28/04

Fazility-Nd. b- /,iLTime In q"" Time Out Date /.-?j1107
Farm Name aSb'r\ Eajmt th c Integrator /' f` =-
„��
Owner y �CA�h _ Site Rep L,-r,w�
Operator
M
Back-up No. _
COC LZ 1A011'1;0W Circle: General or NPDES
Design Current
Design Current
Wean - Feed
Farrow - Feed
W - i ' h
Farrow - Finish
eed - EbW
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test Wettable Acres _
Weekly Freeboard ,--"'Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
U �.
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker -
PLAT �f
1 -in Inspections
N(N7 Date Nitrog
Pull/Field Soil Crop Pan Window
A -.`�' 1�'�a .. —o Cl-
P
I I I CL 6, d/3 I c::-,) I N_�� - �_(n I
l a cI I I Met r- 0c``' J
T �IN I ren&n y vC4
In —
A/m -4, 'e w�

it
® Division of Water Quality
IFaeility Number Z 3 $ M Division of Soil and Water Conservation
�_
Q Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: LtiDeparture Time: //,' County: _r0A1 Region: 1451�
Farm Name: L . Owner Email:
Owner Name: � �Q-S4�✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: L/•� �QO� 4—IZ.SO /V_Title OW f fe Phone No
Onsite Representative: /_# ^roo'j ru Integrator: �u eP�i•, gpvLJ AJ
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 d 0 « Longitude: =0=6
°=6 =
t Design Current Design Current
Sne
Disebarges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IN No
❑ NA
lui—elpffli,,urrer
apulation
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑Dai Cow
❑ Wean to Feeder ❑ Non -Layer
❑Dai Calf
Feeder to Finish 2
` "`
Dai Heifer
❑ Yes
❑ Farrow to Wean
Dry poultry
❑ D Cow
c_ What is the estimated volume that reached waters of the State (gallons)?
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ NA
Gilts
❑Non -La ers
❑ Beef Feeder
MNo
EBoars
❑ Pullets
❑ Beef Brood Coid
❑ Yes
�pNo
❑ Turkeys
❑ NE
other than from a discharge?
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Page I of 3
12/28/04
Continued
Disebarges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IN No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
1p No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
(�PNNo
❑ 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
ONo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�pNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

facility Number: $ Z, —1 3 Date of Inspection — Z3-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
%No ❑ NA ❑ NE
-Structure i Structure 2 Structure 3 Structure 4 Structure
5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in): �or
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Observed Freeboard (in): 32— er
No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
❑ Yes
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?
18. Is there a lack of properly operating waste application equipment?
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
NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
KNo ❑ 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
O(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?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[50No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ElApplication Outside of Area
jt--IWindow
�
12. Crop type(s) 43ec� C+-0._ ts-. S7i-,n,t (te l �•! V t�5>!�OL J
Ywt l
13. Soil type(s) j9u n', �i�lf C —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PA No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
iComments (refer to question #) Explain any YES answers and/or any recommendations or any other comments
,kUse;drawings of facility to better explain situations. (use additional pages as. necessary}
..
ReviewerAnspector Name F j C' !t eVt is Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1.2/28/04 Continued

Facility Number: $z — 3 Date of Inspection $'z3'O
Required Records & Documents ,tT,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropriate box. ❑ }YUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
VS NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[$NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[SNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CgNo
❑ 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
[gNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P4 No
❑ NA
❑ NE
Additional Comments and/orDrawings:.
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04