820198_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

TL
ivis"io'n f Water Resources
N
FaciiGty NumUer ®- ®DiOO Othr Ag
vision of Soil and V1"ater Conservation
ee, ncy
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:E; `QD County: ly — Region:
Farm Name: �,l./ 'jt� ter` 5 c;- — �"~� Owner Email:
Owner Name: �" �r� `S"" Phone:
Mailing Address:
Physical Address:
Facility Contact: ZA2ff/ e ��, �%r�Soz Title: L'P_d'tj l' -r/
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 174D 3
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,BTto ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No [:INA ❑ N E
❑ YesNo❑ NA [:]NE
❑ Yes [EI -N -o ❑ NA ❑ NE
Page I of 3 21412015 Continued
Design Current
Design
Current
Design Current
Swine'"'
Capacity ` Pop Wet Poultry
Capacity
Pvp.
= Cattie Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
_
Dairy Heifer
Farrow to Wean
Design,
Current
Dry Cow
Farrow to FeederP,oult`
Ca aei
P.o . '
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
.: Lathe . . . . . . . . . . . . . . . . . . . . . . ......... ........
............... urkey PoultsJIT
,
Other
Other'
ANSI,
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,BTto ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No [:INA ❑ N E
❑ YesNo❑ NA [:]NE
❑ Yes [EI -N -o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?❑Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):—
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes El No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 46 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 VNo
❑ NA [:]NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 10 ❑ NA [] NE
maintenance or improvement?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�-
13. Soil Type(s): &111;1 %S /i% C1>
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]INo
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
[3] Nu
❑ 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
ffNo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cj<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design p Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F](No ❑ NA ❑ NE
Page 2 of 3 2/4/2075 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 0 No [:] NA [D 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 Vo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'�lo (DNA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E3 -No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rare;
No ❑ NA ❑ NE
F�to❑NA ❑NE
NNo ❑ NA ❑ N E
Phone:
Date:
2/4/2015

ytrc US r 151L: V •.uu1VeianeC 1 u5Nr%;uuu V vperauvu IcevIew V airuciurr c,v211uau131] V i CFZUUIC211 Pkbblmanee
Reason for Visit:-OT�outiue 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time:t'7a County: Region:
Farm Name:�= �,rg�+—,t/1'L Owner Email:
Owner Name: �,( jayrl ���LyiS�'^� Phone:
Mailing Address:
Physical Address:
Facility Contact: A14_72f Title:
Onsite Representative:
Certified Operator: �J�r
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: /, 03
Certification Number:
Longitude:
NMI
:9
�Z No
R
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
DesiRM
gn
Design Gnrrent
Swine
Capacity °Pop:
VVet Poultry
iCnrrent
Capacity i� Popi!
Cattle �� @specify Pop.
Ii
.
❑ No
IN
❑ NE
Wean to Finish
La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Dai Cow
❑No
Wean to Feeder
�C]
Non -La er
❑ Yes
ta No
❑ NA
Dai Calf
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Feeder to Finish
[] NA
❑ NE
Dai Heifer
Farrow to Wean
gn Current
ffma
D Cow
Farrow to Feeder
D P.©vl
c'
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
5i .ji 3!
'LI
Other
Turkey Poults
Other
Other
Discharges and Stream ImDBCtS
1. Is any discharge observed from any part of the operation?
❑ Yes
�Z 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
ta No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[] NA
❑ NE
of the State other than from a discharge?
JRNo
Page I of 3 2/4/2015 Continued

Facili Number: jDate of Ins tion: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E!�-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �c5
5. Are there any immediate threats to the integrity ofany.ofthe structures observed?
❑ Yes
R,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
0 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
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�3 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 Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
[SNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): -
13. Soil Type(s): wZJLZ._Z,a - - - -
P
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 [D 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 Cig-No ❑ NA ❑ NE
❑ Yes [3 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 [Q 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 X No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
0 N ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �jNo
S
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes SNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes EANo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
win s fer to tr estion. y additional reco F ,dations or,any other comments.
Comments (refer to qu,.. #) Explain any YES+auswers andior, an ad mmen
Use drff g 'ty!to better explain situatioiis:(use:additional }pages as neeessary�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
2/4/2015

M
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '-44 Departure Time: County: So o><a� Region: Fl�D
Farm Name: i�t/s�trtp+�- l ^ Owner Email:
Owner Name: W,YG Sa.� r.sr,n _ Phone:
Mailing Address: 3 %1IL(O I-/arr[llS 4/L �,fAe14Y
Physical Address:
Facility Contact: klla 0 s -A r2 ejllrco In Title:
Onsite Representative: S
Certified Operator: b/ r
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: /7.W
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes. notify DWR)
2_ is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes G211Vo ❑ NA ❑ NE
❑ Yes [�'No
❑ Yes 0 No
❑ Yes [2rNo
❑ Yes ETNo
❑ Yes ER No
❑NA ❑NE
❑NA ❑NF
❑NA ❑NE
❑NA ❑NE
[]NA ❑NE
Page I of 3 2/4/2015 Continued
Design Current
Design Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Cap.actty _' Pop.
Cattle Capacity
Pop.
Wean to Finish
f a er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
ceder to Finish
M
Dairy Heifer
Farrow to Wean
=
Design' .Current
Dry Cow
Farrow to Feeder
- D .0. iP,oultry
Ca . actI'o ,
Non -Dairy
Farrow to Finish
l a ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes. notify DWR)
2_ is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes G211Vo ❑ NA ❑ NE
❑ Yes [�'No
❑ Yes 0 No
❑ Yes [2rNo
❑ Yes ETNo
❑ Yes ER No
❑NA ❑NE
❑NA ❑NF
❑NA ❑NE
❑NA ❑NE
[]NA ❑NE
Page I of 3 2/4/2015 Continued

[FacWty Number: .2- jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [E <o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '
Spillway?: 110
Designed Freeboard (in):
Observed Freeboard (in): L.[ 1 //
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 0211�o ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2"'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P<o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(D<o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ ccessive Ponding ❑ ❑ Frees ❑ vy e
s u, Zn, etc.)
❑ ?AN ❑ PA 3 TO% or ❑ Total porus ❑ Fai o ncorpora a anurc
u ge into Bare Soil
❑ ow--
of Approved Area
12. Crop Type(s): �iGrInteW oye.-seed
13. Soil Type(s):/' ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E?,'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [J,/No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes [a-lCo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? s l,'< ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes F,_14o ❑ NA ❑ NE
the appropriate box.
3wm ❑C-lsec lists ❑-Design ❑44ags ❑ ❑Other:
21. Does record keeping need improvement'? If yes, check thea -lo propriate box below. ❑ Yes ©❑ NA ❑ NE
1 to - t.Vy jt- i ter f 6.9 7•
❑st�alina ❑ �] Soil Anal sis ❑ ❑
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes L21F4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L21<o ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

•IFac4Kty Number: Q1 - 1 `1 S Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &]I<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ o ❑ NA ❑ NE
the appropriate box(es) below.
❑ F ' ey ❑ eve op a or s u g els
❑u ge eve stn anylagoon
Liste:
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 facility9 if yes, check the appropriate box below.
❑ AcppiieafivirField ❑ 6agee eftrag&41and ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA Q E
❑ Yes llc!"<o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes E2 -No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes 0 No
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinLs of facility to better explain situations (use additional napes as necessarv).
Reviewer/lnspector Name:
Reviewer/Inspector Signature: M (&r M
Page 3 of 3
Phone: glo LI.3 3 `33s�,
Date: 1 I - 3 —1 &
2/4/2015

f
Type of Visit: WCompli" cc Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outme O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I 7__7 Arrival Time:: �+7 Departure Time: ► �0 0 1 County: Region:
Farm Name: U /f ,r C---- a'-O—f-- Owner Email:
Owner Name: �.(J Q �j Ga-n04'n4erL– Phone:
Mailing Address:
Physical Address: /
Facility Contact: t/yci7 ��/SDti Title: 914.y17 ai` Phone:
Onsite Representative: Integrator:
Certified Operator: ,����� Certification Number: .0Fz_C'hq 34
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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)?
❑ Yes P!;,No ❑ NA ❑ NE
❑ Yes
Design Current
[] NA
Design Current
Design Current
Swine
Ca act _ p.
p ty=.. Po
Wet P oultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
[Non -Layer
airy Calf
Feeder to FinishO
Dai Heifer
Warrow to
sign trent
Cow
Farrow to Feeder
D po
ult ,
Bit
aci Pio p -
Farrow
Farrow to Finish
I.a ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- --- -
Turkeys
Othert,*=
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)?
❑ Yes P!;,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 E2[,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [RNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C3,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No [:]NA [:]NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
Facili Number: - Date of Inspection:
❑ Yes
g No
❑ NA
❑ NE
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
®Yes
2—No
❑ NA
❑ NE
a. If yes, is waste level into the structural frceboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 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
DNo
❑ 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
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ 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
NNo
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C3,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No [:]NA [:]NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
g 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 �Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes allo
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 2/4/2014 Continued

Facili Number: jDate of inspection: S�
I 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FUI No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 N ONE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ® No [] NA ❑ NE
❑ Yes 25 No ❑ NA ❑ NE
[:]Yes
10 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: '9jD y33-3'�- 0D
Date: /G —0�bi,-
2/412014

sr/-� I�-3l-avi►(
* Division of Water Resources
Facility Number ®- / ©Division of Soil and Water Conservation
CO Other Agen,�cy
Type of Visit: Q Compliance Inspection C3 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: a Departure Time: ; 3a County: Region:
Farm Name: (,(fqw y� S �2r�Q..r., /n'�' Owner Email:
Owner Name: 1 %�� Q 5��yls Phone:
Mailing Address:
Physical Address:
Facility Contact: Z4_22y,�„ Title: ��(/y Phone:
Onsite Representative:`��-- Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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?
❑ Yes �o 0 NA ❑ NE
❑Yes
[3 No
❑NA
0 N
❑ Yes
[] No
Design Current
❑ NE
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
a er
D Cow
Wean to FeederF
LINon-Layer
D Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D � P,oul
G aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OtherI
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?
❑ Yes �o 0 NA ❑ NE
❑Yes
[3 No
❑NA
0 N
❑ 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
0 Yes
®,No
❑ NA
0 NE
❑ Yes
&No
❑ NA
❑ NE
Page 1 of 3 214/2014 Continued

Faciti Number: - Date of Inspection:
❑ Yes
J[allo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Qg:No
❑ NA
❑ NE
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z Vo
❑ 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:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EE�IVo
0 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
E8,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[—]Yes
LNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ 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
QS�o
❑ 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. Soil Type(s): ,(%p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes EgNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
J[allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Qg: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
fallo
❑ 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes JZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes La No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JKNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes X[No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
,®,No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fgNo
❑ 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
I&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
O—No
[DNA ❑ 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
2�Vo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Jallo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
E]Yes
C No
❑ NA ❑ NE
Comments' (refer to goeshon #) I✓aplain any YES answersandlor any additional recammendan�orAany o#her comments.
Use:drawings of,facility to, better explain situations (use,addihonal pages as:necessary
f
Reviewer/Inspector Name: _'F-��G 6-�Z� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 214/2014

A
Type of Visit: E)Tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access IJ
Date of Visit: —/3 Arrival Time: D r7 Departure Time: ,' County: Region: y7C O
Farm Name: �ii�jq f �Qy�rr� t3f ✓ /YL� Owner Email:
Owner Name:�4 Phone:
Mailing Address:
Physical Address:
Facility Contact: !C/ rr� 'sa,��r,rsa`z� Title:�hr/' Phone:
Onsite Representative: ^ Integrator: �ZL4
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'
Design Current
.
1 -.
Destgn�Current
Design Current
Swine Ca ace Po p•
P t3'
Wet Plinit .
rya
Ca act Pop . ' -
p ty
Cattle Capacity Pop.
Wean to Finish
I ILayer
❑ Yes
[:]No
❑ NA
Dairy Cow
Wean to Feeder
❑ Yes
I JNon-Layer
I
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish /
__
Dairy Heifer
E] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Farrow to Wean
❑ NA
❑ NE
Desi n Current
Dry Cow
Farrow to Feeder
❑ NA
D , P,oultt v
Ca ag 1',0A
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
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?
[-]Yes
®-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (1f yes, notify DWQ)
❑ Yes
E] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[a No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 3—
❑ Yes
[�No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
F�kNo
T
❑ NA
❑ NE
4. Is capacity storage ca
g p ty (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
allo
[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?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E[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
[gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): AVAZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Callo ❑ 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
F�kNo
T
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VrNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

jFacHity Number: - Date of Ins ection: 62 — f3ip 13
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 O 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J?10-11(5 -330
Date:
2/4/2011

I
Type of visit:ompli nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Izeason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / -- / Arrival Time: ! pfl Departure Time: ! CQ County: . - Region: /_lz0
Farm Name: kla-Le .� ez<i� --.. �Gcr„-�- Owner Email:
Owner Name: D S .r/S ate- Phone:
Mailing Address:
Physical Address:
Facility Contact: �,lJ�ti yp z5- s../��- Title: /'�CUhr/ Phone:
Onsite Representative: .f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: / 7 '? 03
Certification Number:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation`? ❑ Yes &jNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes D 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)?
Design Current
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Design'
CurrentDesign
Current
❑ NE
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
[:]Yes
Wean to Finish
❑ NA
❑ NE
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P,o_ul
Ca aci
Pio P.
Non -Dairy
Farrow to Finish
]Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
_-��Pe:e�.ca'>
wy':n:�.;®x.,�w�::«.n.-:x
.:...
.- s.,:.waa.��.u'��rrw�.
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation`? ❑ Yes &jNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes D 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
Eallo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
SNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facifi Number: - Date of Inspection:
[:]Yes
® No
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
® No
❑ NA
❑ NE
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
Ej§,No
❑ NA
[] NE
a, if yes, is waste level into the structural freeboard?
[] Yes
0 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
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.)
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2. No
❑ NA
❑ NE
waste management or closure plan?
21412011 Continued
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_
[:]Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): bu; $ %
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [SNo DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ 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?
❑ Yes
[Q No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: g2= - Date of Inspection: -/�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EZ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 0 NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �0 No ❑ NA ❑ NE
[] Yes [3 No ❑ NA ❑ NE
❑ Yes [Z No
Yes [3 No
[—]Yes ®, No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question i#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name: p�"C _-rJ�yr� _ Phone: �`/t0
Reviewer/Inspector Signature: Date:��f4��%
Page 3 of 3 2/4/2011

Type of visit: ercompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
[season for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:, f� --� Arrival Time: D Departure Time: U County:
W
Farm Name: ar-y/!e ,Su.dfPrs�� ��r'�'� Owner Email:
11
Owner Name: W.OL4eAl Phone:
Mailing Address:
Region: /_�O
Physical Address:
Facility Contact: Gey� _ zjcc,.,,�,a� B,� Titte: ®-e.e���/ Phone:
Onsite Representative: S te_ Integrator: Zf_, .may
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Capacity Pop.
PR0Swine
Wet Poultry
:. opacity
`@
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ Yes
❑ No
❑ NA
❑ NE
iry Cow
Wean to Feeder
Non -La er
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
iry Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
iry Heifer
Farrow to Wean
❑ NA
Design
Current
Dry Cow
Farrow to Feeder
D . P,ottitCa
aci
Po P.
Non -Dairy
Farrow to Finish
La ers
[] NE
of the State other than from a discharge?
Becf Stocker
Gilts
Non -La ers
Becf Feeder
Boars
Pullets
Becf Brood Cow
_. -.
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Appiication 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)
E] Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E& No
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection: — 81� pb/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q 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
jQ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or cgmpliance alternatives that need
[—]Yes
e No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop /Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):z-i'�nrc���BvYr�lrrd �C�--
13. Soil Type(s): ji(J Z 7
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?
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 ® 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 S No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'! ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: f - Date of Ins eetion:Z2—�ajj
24. Did the facility fail to calibrate waste application equipment as required by the permit?] Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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.
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes JE No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
[:]Yes J5 No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ®, No
[:]Yes VI No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: }J0 j::y 3 -33Z
Reviewer/inspector Signature. ��,,� Date:
Page 3 of 3 214/2011

i
t
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visitoutine
Q Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: `49 (7 Departure Time:: O(7 County: Region:01
Farm Name: Yi/ rl r San.r/��� '"- r-- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: //
Facility Contact: <z�s 4r 04 Title: 1_26'' fe' Phone No:
Onsite Representative: Integrator:z����
Certified Operator: -s'"- - - Operator Certification Number: Z 72Y
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [ o =' 0 Longitude: =0=6
°=6 0
go
Design Current
❑ Yes
Design Current
Design Current
S�°ine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Yes
❑ Dairy Cow
❑ NA
❑ NE
❑ Wean to Feeder
❑Non -La er
❑ No
❑ Dairy Calf
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
® Feeder to Finish 40 3
❑ Dairy Heifer
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Farrow to WeanDry
Dr Poultry ' '
Cow
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Farrow to Feeder
No
Non -Dairy
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ NE
other than from a discharge?
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood owi
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 9�;;L Date of Inspection—/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -Y";I-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JZ No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
FX] No
❑ NA ❑ NE
through a waste management or closure plan?
Soil type(s)
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
H No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
N No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
15.
9. Does any part of the waste management system other than the waste structures require ❑ Yes
91 No
❑ NA ❑ NE
maintenance or improvement?
❑ NE
16.
Waste Application
❑ Yes
0 No
]0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
❑ Yes
B No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
aND
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
91 No
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ESNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
B No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
91 No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:2%Q — —33p a
Reviewer/inspector Signature:git�Date: 1;,2—�'2 :moo/ o
Page 2 of 3 12/28/04 Continued

Facility Number: 8' — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ($ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes (S No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El 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 ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R1 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JO No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JO No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
' No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional C�mebts andloirtDra�vings .,
i
Hw
12/28104

Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit eal5utine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �— Region:
Farm Name: -fir J16o ✓�- _ _ Owner Email:
Owner Name•Ldz19L e_�P/�4Trr' _ Phone:
Mailing Address:
Physical Address: _
Facility Contact: ��7a,4 , Z arm Title: 0,.LZ;E, _ Phone No:
Onsite Representative: Sa--u Integrator:'�/r��
Certified Operator: � Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=f
0 Longitude: =0=1 = u
Design Current
Design C►urreot
Design Current
Swine Capacity Population
Wet Poultry C*apacity Papulation
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ NA
❑ Wean to Feeder
❑ Non -Layer
❑ No
❑ Yes
❑ Dai Calf
® Feeder to Finish
❑ NE
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes F7,'1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(4 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128/04 Continued

t
Facility Number: — Z Date of Inspection
NVaste Collection & Treatment
Reviewer/inspector Name zxf Phone:
Reviewer/Inspector Signature: -1 Date:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
15?LNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Stricture 1 Stnicture 2 Structure 3 Stnicture 4
Structure
5 Structure 6
Identifier:
Spillways?:
Designed Freeboard (in):
Observed f=reeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
No El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
N No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J. No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes T -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 19 -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes 9No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes N -No ❑ NA ❑ NE
[]Yes Ejj No [:INA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w►
Reviewer/inspector Name zxf Phone:
Reviewer/Inspector Signature: -1 Date:
1228/04 Continued

Facility Number: --� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box. ❑ WUp 0 Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EELNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
BNo
❑ 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
0,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
JS,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RN
❑ NA
❑ NE
Addrf,ortal Comments"and/or°Draw;rigs
121MA04
121MA04

Type of Visit WCompliance Inspection ()Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit 01outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: rQ �a Arrival Time: Departure Time: County: Region:
Farm Name: �`� Owner Email:
Owner Name: _�J czy,d�'✓S ^-= Phone:
Mailing Address:
S�
Physical Address:
Facility Contact:_Title: Phone No:
Onsite Representative: S -t Integrator: p
Certified Operator: Operator Certification Number:
Sack -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 El I ="
Longitude: = 0 0 I = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Current Design Current
Swine _
Capacity Popu� lation Wet Poultry.
Capacity Popylatibrr` Cattle Capacity Population
❑Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder❑
❑ Yes
Non -La er
❑Dairy Calf
❑ Feeder to Finish
b. Did the discharge reach waters of the State? (If yes, notify DW Q)
❑ Yes
❑DaiHeifer
❑ NA
❑ Farrow to WeanEl
c. What is the estimated volume that reached waters of the State (gallons)?
o
DryPultry*,
Dry Cow
_ .,
❑ Farrow to Feeder'
❑ Yes
S ❑ La ers
ElNon-Dairy
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El Farrow to Finish
❑ NA
z;
A ❑Bee f Stocker
❑ Gilts
KNo
❑Non -Layers
❑ Beef Feeder
❑ BoarsElPuilets
,
Turkeys
El Beef Brood Co
Other 's
.. 4 ❑ Turkey Poults
12/28/04
❑Other
Other
-_ Number of Structures:FTI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JXNo
❑ 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 DW Q)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
;.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number. -,$A'— / Date of Inspection V--cle
Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 21 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes DKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 N ❑ NA EINE
maintenance or improvement?
Waste Auolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceof Wind Drift ElApplication Outside of Area
YLL
12. Crop type(s) rjJ,zd—jzr ! nU'ee'.S".,lfI %
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ®,Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 N
❑ NA
❑ NE
Commts7(refer t0{gltestton'#) E plain an} YES answers andlor any recommendother comments.
;Usedrawrngs of factlity to betteregplam sttaahons (ase addtttoaaljpages as necessary,
'-v{ rub
Xues_ 17�P� t_ hrr�a r�pf 6 — �Li �L7 i 69—� d--3 "J t x ',ft —
f v � fir, - Ceo+-ft -To Tr r- e "s, 0:-6
Reviewer/Inspector Name Phone: D '�
Reviewer/Inspector Signature: Date:
Page 2 of 3 , 12/28/04 Continued
ter,

0
Facility Number: V —Date of laspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes E&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes M No [INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2FNo ❑ 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
E4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
O 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
® No
❑ NA
❑ NE
t
Additional.Comeand/or Drawings::. -=fes "1
mats, :. .
Page 3 of 3 11/28104
Page 3 of 3 11/28104

vision of Water Quality .�G.
1 Z Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit @-15o_mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *<outine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ! D a Departure Time: County: Region:
Farm Name: UXJ" %? S �.�56 �/` � _ Owner Email:
Owner Name et—%- 2� Phone:
Mailing Address: ���� ��� �'�� �Q/�`��_ G. "q
Physical Address:
Facility Contact: rx ,1 >• � _-r 0--- Title: Phone No:
Onsite Representative: S'o—�- Integrator:
Certified Operator: _^ Sdr�-..r 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
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = [=d =4 Longitude: = ° =I
= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
! ❑ Nan-Lavet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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)
Cattle
Design Current
Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 41
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — e Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate'!
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ® No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 5d No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA Cl NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%ori 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s)9 _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KL No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes EK No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
K No
❑ NA
EINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RoNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name ep � Phone:
Reviewer/Inspector Signature: Date: 3 r:1;90 p
12128104 Continued

i
i Facility Number: Date of Inspection �7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fSNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5d No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9 -No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
BNo
❑ 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
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V) 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
CKNo
❑ 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
51No
❑ 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
B No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NLNo
❑ NA
❑ NE
Comments,and/or Drawings:
Page 3 of 3 12/28/04

al Q Emergency Q Other ❑Denied Access
Date of Visit: rrival Time: ,��t} Departure Time:. (10 County: Region:
Farm Name: L ,e .. ez,o &Z!; -, 11ir ✓Wk- Owner Email:
!
Owner Name: U417 Phone:
Mailing Address: 3 p Q tt! > � ef-r`//-S
Physical Address:
Facility Contact: Y�)02!e Title:
Onsite Representative:
Certified Operator:
Bach -up Operator:
Phone No:
Integrator: E/ Z� i,...�
IV
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ ` 0 u Longitude: = o =' = u
Discharges & Stream Impacts
"
❑ Non El
ers
El Pullets
1:1 Turk
El Turkey Poults
❑ Other
Type of visit e"Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit @,tfoutine Q Complaint 0 Follow up 0 Referr
1. Is any discharge observed from any part of the operation?
Design Current Design Current
.51111
Design Current
Swine
Capacity Population Wet Poultry Capacity Popnlatioq,.,
Cattle Capacity Population
IR❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
Feeder to Finish
'`
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
Dry Cow
❑ Farrow to Feeder
`�
? ❑ Non -Dairy
❑ Farrow to Finish
Layers
El La
❑ Beef Stocker
❑ Gilts
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
� ❑ Beef Feeder
❑ Boars
El NA
❑Beef Brood Cowl
?. Is there evidence of a past discharge from any part of the operation?
e s
No
Other
w._
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Others
j$.No
Number of Structures:
El NE
,
Discharges & Stream Impacts
"
❑ Non El
ers
El Pullets
1:1 Turk
El Turkey Poults
❑ Other
Type of visit e"Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit @,tfoutine Q Complaint 0 Follow up 0 Referr
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
El NA
E) NE
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
No
❑ NA
El NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
El NA
El NE
?. Is there evidence of a past discharge from any part of the operation?
[:1 Yes
No
El NA
[-INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
j$.No
El NA
El NE
other than from a discharge?
Page I of 3
12/28/04
Continued

'
Facility Number: — 4 Date of Inspection
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
SNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19,
Observed Freeboard (in): :U
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ZNo
❑ NA
EINE
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
"RNo
El NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZLNo
❑ 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
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9No
❑ NA
❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
91No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s) 61 Gfo!# ,J
13. Soil type(s) waw l C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR 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
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C&No
❑ NA
❑ NE
t�8d �dfy..✓
Reviewer/Inspector Name �ti �� F - Phone: f o r 3 33a—
Reviewer/Inspector Signature: Date: & (P
12128/04 Continued

Facility Number: Date of Inspection (o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P�.No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes FNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [H No ❑ NA EINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EU No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
U1No
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
D,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KI 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
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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation 1
Reason for Visit S Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number g Date of Visit: - ?3'a' Time: ��
O Not Operational 0 Below Threshold
©.Permitted �rdfiied 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ... ...... S r,, County:....... c.n...................... W__...F (?.........
Owner Name: ,tri ....... Sa �I�� �......_....._............. Phone No: `l/U •3 -zri?.
vl "' Address: .... �Z r�r �c_1 _��rr . !V L __2 $ �✓`d �_�� �Ww __._.._
Facilit_r Contact: ..!�✓ .y t..Z.e.._.._ aLad1Pl_S_Q a_.....------T-Itle• Phone No: 9/0 ' 3��`� ��� f
- '✓- �5Onsite Representative•-•--.Integ1ator: __ P.f' ..f� ry ..W.�s� ar. S _ . __��••---
�•
Certified Operator: ........ ✓ay.a.e.... Operator Certification Number:_..I.
Location of Farm:
♦t
[9.801ne ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� Ops
Discbarees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9.90
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes QTo
c. If discharge is observed, what is the estimated flow in gal min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes UNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [3 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:... ........................ ....... .._.............................. ................................... ...................................
Freeboard (inches):
12112103 Continued

Facility Number: Y,2
Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anvlicafion
❑ Yes ❑110-
❑ Yes &No
❑ Yes ONO
❑ Yes Q No
❑ Yes RNo
10. Are there any buffers that need maintenancerimprovement? ❑ Yes Q No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes PNo
❑ Excessive Ponding// ❑ PAN /❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type UP r rn urea � rG s 4 f ".R J1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes DWO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E�M
b) Does the facility need a wettable acre determination? ❑ Yes [.bio
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes Eallo
16. Is there a lack of adequate waste application equipment? ❑ Yes E kNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [9 -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONe
Air Quality representative immediately.
COIII@eaLS refer to ;gIIesLOn � ?E�cplam agy I'ES answers and/,Or any. _I endatior Or aIIjT Other comments
Use dcaw► igs of qty to better cxplat� s txtattw (trice iddt a pages necessary) ❑Field Co ❑ Final No
Fgrtn A4_. J orifi lie cc%'"r- S an 61 is c ,ell I�tP�l
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -3 Lj
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PM
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
©No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
min
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EJ -No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
G -Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ddb
27_ Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
❑Wo
28. Does facility require a follow-up visit by same agency?
❑ Yes
MNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
El -No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
R -fes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 -iso
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ O
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
O -N-0—
34_ Did the facility fail to calibrate waste application equipment?
❑ Yes
E] -No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
[-io
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Add iii onid Co- rnraents and/or Drawrngs _ s
7 [ 3.3 / 1 I !� 1 7 / S�,Jc<J 144_ Y/'Cs vle h45 do') �,s S/vs/Ji c Svrv[�, dvT 7�4e�
r,
12112103

Facility Number. 8.2 -/ 97d?
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: - / -3
Time: ly,�
ti
General Information:
Farm Name:,cJF S N�IIq
rert County: ��•✓
Owner Name: ulA, ojc l Qa-o-�A) _ _ Phone No: --s z - D z,-5—
On
,SOn Site Representative: 0� - ,!gA16criso,d Integrator: f Pe_
Mailing Address: _4EWAj- r k0l
Physical
Latitude: / / Longitude: I 1
Operation Description: (based on design characteristics)
Type of Swine No. of Ani als Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ?-Y4,9 ❑ Layer ❑ Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
❑ Feeder
OtherType of LivestockNumber of Animals:, a�
Number of Lagoons:_ (include in the Drawings and Observations the freeboard of each lagoon)
Facility, Ins-pection:
Lagoon
Is lagoon(s) freeboard less than 1foot + 25 year 24 hour storm storage?: Z. L ry r
Is seepage observed from the. lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made O Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which Meed improvement)
Crop type: Acreage:
�,fP✓o ALI
Yes OVNo
Yes ❑ No U----
Yes
�Yes Zr' No ❑
Yes ❑ No�
Yes d___No ❑
�NoN rte)
Yes d' No ❑
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 104 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI - January 17,1996
Yes ❑ No
Yes ❑ Vo � . -.
Yes ❑ No
Yes ❑ No

Maintenance
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan nn sire?
Yes a
No
Yes ❑
No,O
Yes U
No�j
Y V� u
lVO,=
Explain any Yes answers:
Z _
cc. Facility Assessment Unit
Drawinzs or Observations:
AOI -- January 17,19%
Date: ->— '1/3 — f,6
Use Attachments if Needed