820218_INSPECTIONS_20171231

Z N
NORTH CAROLINA
Department of Environmental Qual

1Type of Visit: Gr1rompliance Inspection O Operation Review Q'Structure Evaluation O Technical Assistance I
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 O/ther O Denied Access
Date of Visit: fl y D 7 Arrival Time: ; J� Departure Time: p County: Region: C7
Farm Name: r r—Q e74Owner Email: �"--
Owner Name: f" Phone:
Mailing Address:
Physical Address:
Facility Contact: /11 �,,o/ Title:
Onsite Representative: �'j 10
Certified Operator:
Back-up Operator:
e9w /1-'0Phone:
Location of Farm: Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design 'Current
Design Current
Design Current
11
et Poul
Finish
La er
Dai Cow
Feeder
7FZder
Non -La er
Da Calf
o Finish
%�
r�Da'
Heifer
o Wean
Design Current
D Cow
o Feeder
D Paul
Ca ael 1'a
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
FTother
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
'❑ Yes Quo
[-]Yes [ o
❑NA ❑NE
❑NA ❑NE
[_],NA ❑ NE
Page 1 of 3 21412015 Continued

lFacility Number: Date of Inspection: /V —10
—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Ej-_;�cs
No
[:] NA
[] NE
a. If yes, is waste level into the structural freeboard?
[2-`�es
E] No
E] NA
0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway9:
Designed Freeboard (in): 'Z
Observed Freeboard (in): I%-,,-
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
E�<o
NA
NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
E] Yes
�o
NA
NE
waste management or closure plan?
If any of questions 4-6 Were Hnswered yes, and the situation poses an immediate publie health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Ej 'Yes;
[3 No
C] NA
[3 NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[�o
NA
E] 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
�E
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need Ej Yes No E] NA E<E.
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No E] NA 0-6
E] Excessive Ponding 0 Hydraulic Overload E] Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
PAN F� PAN > 10% or 10 lbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window 0 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
E] No
[] NA
ED14E
15. Does the receiving crop and/or land application site need improvement?
El Yes
El No
0 NA
Et�E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[3 Yes
Ej No
Ej NA
F7r1TE_
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
0 No
[-] NA
EWE
18. Is there a lack of properly operating waste application equipment?
E] Yes
[D No
0 NA
E7`NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
No
NA
Ej<
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
No
NA
E]5E
the appropriate box.
E1WUP El Checklists [:]Design E] Maps [:]Lease Agreements [—]Cfther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. E] Yes [:]No
El Waste Application [:) Weekly Freeboard El Waste Analysis E] Soil Analysis El Waste Transfers
F� Rainfall 0 Stocking Ej Crop Yield E] 120 Minute Inspections E] Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-] Yes E] No
NA ff5E
Weather Code
Sludge Survey
[—] NA B15V`
[j N A El-Nt'
Page 2 of 3 21412015 Continued

FF-mber: :�Lj Date of inspection:
24- Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
D No D NA ErgE-"
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
D Yes
D No D NA [2-Tqt
the appropriate box(es) below.
D Failure to complete annual sludge survey Failure to develop a POA for sludge levels
El 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?
E]YesE]No
DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
OYes[:]No
DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
[:] No 0 NA [ErK'E-
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
D-'g-o 0 NA [D NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notif-y the Regional Office of emergency situations as required by the
EKs
Ej No D NA [:] NE
permit? (i.e., discharge, fireeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
No D NA L2-51�
El Application Field D Lagoon/Storage Pond F� Other:
32. Were any additional problems noted which cause non-compliance of the pem-fit or CAWMP?
D Yes
[3fq_o__D NA D NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
ETY�es
E] No [DNA D NE
34. Does the facility require a follow-up visit by the same agency?
Z'Yes
Ej No D NA C3 NE
/V0 t�j�' Mt-,
/V"", "5 a �j 44j/// Lj- e-11 5D D
/-00 ek��� 1--ap"Vq ez)-ZJ1 -
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of -3
Phone: .9-1—'9 3LCD_y:f 14U
Date:
21412015

I'ype of visit: U Compliance Inspection U operation Review Q-yNtructure Evaluation U Technical Assistance
P Reason for Visit: 0 Routine 0 Complaint 0 Fol.low-up 0 Referral 0 Emergency 0-10iber 0 Denied Access
'." I
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Faeflity Contact: Title: ZD CA_j ^-e' J,'- Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 'Xi -A-
Certification Number: ZP 0 32-2 (-
Certification Number:
Longitude:
ent ign UK,
lop.
D—esign Cbugnt
apa ity 'a
�_p
to Finish
Dairy Cow
nto Feeder
Dairy Calf
Feeder to Finish
Wu ent
r
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
I 113eef Feeder
Gilts
Non -Layers
Boars
Pullets
[Beef Brood Cow
e
Lt
TurkeXs
Turkex Poults
fther
Discharizes and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: F-1 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?
Ej Yes EEj-<o [:] NA [:] NE
[:] Yes
No
D NA
NE
[:]Yes
No
E] NA
NE
Yes
[:] No
Yes
[Ej-Tq'0
Yes
[]-Zo
[:] NA NE
DNA NE
[:] NA NE
Page I of 3 21412015 Continued

lFacility Num;er: FDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? M-y-es 0 No 0 NA [:] NE
a. If yes, is waste level into the structural freeboard? D-1-es 0 No C:] NA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Jdentifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes []��o NA N E
(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 D<o NA N E
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? Et-Y-'es 0 No NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? Yes E]"'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 0 Yes 0 No EDNA Erl�E
maintenance or improvement?
Waste Apglication
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes [—] No D NA Eyi��
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes E] No D NA [allt'
F1 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Studge into Bare Soil
Outside of Acceptable Crop Window [:] Evidence of Wind Dfift 0 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
ReQuired Records & Documents
19. Did the facility fail to have the Certificate Of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
[:]No
D NA
Ej_NE
0 Yes
D No
D NA
2-Nt
Yes
[:] No
D NA
Ej'5E
E]Yes
0 No
NA
E�t<
E] Yes
[:]No
NA
�E
[:] Yes Ej No NA ET —NE
0 Yes Ej No NA E�J�
[:]WUP [:]Checklists DDesign [:] Maps D Lease Agreements 00ther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes 0 No
Waste Application 0 Weekly Freeboard E] Waste Analysis 0 Soil Analysis [:] Waste Transfers
Rainfall E] Stocking 0 Crop Yield El 120 Minute Inspections D Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E] Yes D No
23. If selected, did the facility fail to install and maintain rainbTeakers on irrigation equipment? E3Yes [:]No
DNA a -NE
[:] Weather Code
Ej Sludge Survey
NA E��
NA Ej�
Pa-
ge 2 of 3 21412015 Continued

Facility Number: IDate of Inspection: Agr
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? Cj 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 property 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application Field El Lagoon/Storage Pond F� 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 SignatuT
Page 3 of 3
<
j b T -
E] NA [D<E
E] NA [D-1qE
NA E�1-9E
NA ETI�M'
Yes [—] No E] NA [3-lqf
C-] Yes HKo [:] NA [3NE
ETY'es 0 No [:] NA E] NE
Yes [D No F] NA El"N'E
[]Yes 0_71�0
E rYs [:]No
Eff.� E] No
NA NE
NA NE
NA NE
7WA i� )we, Xm79� 6 J 7Te:41c u-1 -�'g
T-0 1,t A17 _r,0;'t 'IV49��e
V� 4' 24- /
Phonc:m-_-�P__�7—e2��
Date:
21412015

I.
i -- - ivisioo of Water Resoni'ces .. ,
ffl_fflcili�Number Diviision of Soil and Water Conservation
U• Other Agency
Type of Visit: O'Co-mpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Arrival Time: ! yD Departure Time: / ,'/ County: Region:
Farm Name: IJ /` ��rl'L Owner Email:
Owner Name: �j vL %%1a YG�/ 2;UllY/ Phone:
Mailing Address:
Physical Address:
Facility Contact: 6d'z-5r/ /Yl'901_ — Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: `r��
Certification Number: /O D s3 20e,
Certification Number:
Longitude:
�'•� :'lid �_ . � .
Des�ga Current
.Ert tea, r y
Ca ace Po
Swine p ty p.
, � , .ii,
i.
Wet Poult ry
� u��, �
�DCurrent
a �.
Ca ac
p I Pop.
Cattle
,�.,13
Design Current
Capacity Pap.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
airy Cow
06
a
Non -La er
Dairy Calf
} €' ` Design Current
ll , P,oul# , Ca aci Po .
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other' Turkey Poults
Other L 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes WNo ❑NA ONE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412015 Continued

[Facility Number ,WJjK 91--�— / ;7
jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm. storage plus heavy rainfall) less than adequate? 0 Yes [S.No F] NA [—] NE
a. If yes, is waste level into the structural freeboard? []Yes ONo [DNA ONE
. 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?
(i.e., large trees, severe erosion, seepage, etc.)
[:] Yes [E No [:] NA [-] NE
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes
[a 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?
IQ Yes
0 No
EJNA
ONE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
C3,No
NA
0 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
EL Yes
[:]No
NA
N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E] Yes
0 No
NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes M No 0 NA [:1 NE
Ej Excessive Ponding 0 Hydraulic Overload [:] Frozxn Ground 0 Heavy Metals (Cu, Zn, etc.)
n PAN F1 PAN > 10% or 10 lbs. 0 Total Phosphorus n Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift Ej Application Outside of Approved Area
12. Crop Type(s). / 'A�
n 14 //X/ - 1-5 094--3 49 L" -e-e-1-5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
0 No
Ej NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
[:] Yes
LK No
0 NA
[:] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
E[ No
Ej NA
El NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
0 No
E] NA
NE
18. Is there a lack of properly operating waste application equipment?
Yes
No
NA
NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
10.4 No
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
rv�
Lnj No
NA
E] NE
the appropriate box.
E1WUP E]Checklists 0 Design [:1 Maps [:] Lease Agreements 00ther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [Q'No 0 NA [] NE
Waste Application Ej Weekly Freeboard 0 Waste Analysis E] Soil Analysis 0 Waste Transfers 0 Weather Code
Rainfall [:]Stocking [j Crop Yield M 120 Minute Inspections [:]Monthly and V Rainfall Inspections E] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes Callo 0 NA NE
23. If selected, did the facility fail to install and maintain rainbreakers. on irrigation equipment? [:] Yes [&No 0 NA NE
Page 2 of 3 21412015 Continued

lFacility Number: F�� - ;Z Fp-ateof Inseection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? OYes PgNo DNA ONE
25. Is the facil 4 out of compliance with permit conditions related to sludge? If yes, check Ej Yes ELNo D NA El NE
the appropriate box(es) below.
Failure to complete annual sludge survey E]railure 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:
MA
26. Did the facility fail provide documentation of an actively certified operator in charge? Ej Yes L/jNo DNA [-] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [a No D NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
E[No
NA
NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
[&No
NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
[allo
D NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Yes
M No
E] NA
NE
0 Application Field Lagoon/Storage Pond F] other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
BNo
NA
NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes
[X No
NA
NE
34. Does the facility require a follow-up visit by the same agency?
Ej Yes
qNo
NA
E] NE
-3
kl_o' /- -.*, �_ ; � t- B V ", e-z'
1 7 " aj 7
Al
/`77 'eu 71�� -
1-7m— _-_3 P
, e /'­_ ev C---
Reviewer/inspector Name:
Phone:
Reviewer/inspector Signature: Date:
Page 3 of 3
214,12015

Type of Visit: 43r-Compliance inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: % a County: Region:
Farm Name: X&&i9_ 4�i rrY\, Owner Email:
Owner Name: Nattje j2 1z'4Phone:
Mailing Address:
Physical Address: ,
Facility Contact:Title:
Onsite Representative:
Certified Operator: /00
Back-up Operator:
Location of Farm:
G- Phone: _
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
igttC went+ " Design Current Desctty
p. Wet Poultry Capacity llop. Ca Capacity Pap.
S y
Wean to Finish
Layer
airvCow
can to Feeder
I jNon-Layer I
Design Current
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
y, D . Paoul Ca aci $o '.
Non-Dai
Beef Stocker
Farrow to Finish
ILayers
Gilts
d
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Otherz=_�*"
Othcr
Discharges and Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ff�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes ❑ No
❑ Yes allo
❑ Yes (No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

']Farility Number: lbate of Inspection:
Waste Collection & Treatment
"14. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
23-yes
ONo
D NA
D NE
a. If yes, is waste level into the structural freeboard?
D Yes
[2[�No
D NA
D NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway;9:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
E] No
D NA
D 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
OYes
JoNo
DNA
ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
No
NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
No
NA
NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
D Yes
No
DNA
D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
D;J�o
[:] NA
[:] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:] Yes 2g-No 0 NA 0 NE
F-1 Excessive Ponding OHydraulic Overload [:] Frozen Ground [:] Heavy Metals (Cu, Zn, etc.)
M PAN F-1 PAN > 10% or 10 lbs. D Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window Evidence of Wind Drift D 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 C3,No D NA D NE
15. Does the receiving crop and/or land application site need improvement? E] Yes allo F] NA ONE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes M-No 0 NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
M No
NA
0 NE
18. Is there a lack of properly operating waste application equipment?
D Yes
E4 No
NA
E] NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
01 No
[:3 NA
D NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
E] Yes
EE�No
El NA
0 NE
the appropriate box.
0 WUP E]Checklists 0 Design D Maps D Lease Agreements 00ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes ��No
OWaste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis OWaste Transfers
F-1 Rainfall 0 StockingO Crop Yield 0 120 Minute Inspections D Monthly and I " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [:] Yes 21 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 2�No
DNA [:] NE
0 Weather Code
D Sludge Survey
[DNA NE
[DNA NE
Page 2 of 3 21412015 Condnued

]Facility Number: jDate of Inspection: IV—,5�zo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E]Yes
BNo DNA []NE
\k
*�25- Is the facility out of compliance with permit conditions related to sludge? If yes, check
Ej Yes
allo [:] NA NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
E] 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?
23-yes
D No DNA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
V�zn No [::] NA NE
;L--r
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes
S No DNA E] NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
ED No D NA D NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
E] Yes
No
NA
NE
permit? (i.e., discharge, fireeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
E:] Yes
No
NA
NE
E] Application Field D Lagoon/Storage Pond F1 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
1�1 Yes
E] No
NA
NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
E] Yes
Ej No
D NA
E] NE
34. Does the facility require a follow-up visit by the same agency?
[:)Yes
W No
D NA
D NE
j -
/'- " C1W7-0---
a - rz 0- V I,, If, -C� IJ
74 7-0
49-0 6-- " r
/
zole ay 7A
J__C
/Uo one
4
Reviewer/Inspector Name:
Reviewer/InspeCtOT Signatut
fl?
T-t 1--e- A--Ioa
-4, , tti, j(,b, A�7 vbLJ-1
Phone: 5�/-,9-3��_3— OfSj
Date:
21412015
Page 3 of 3

1VOD-'�&)s- ;Pc---3 6'�tr
acifi—KINUM e wouse - tjon
rypeofvisit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit: 9�utine OComplaint OFollow-up OReferral OEmergency 00ther 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Countyi���_101__ Region:
Farm Name- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 74
Phone:
Onsite Representative: Integrator:
/
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
esi urre
wapacl
Des" I-puesign
Ht, 6" aci o
S;r;r.—ent
a ILMrop.
inisb
eeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
cr_
Dairy Cow
Dairy Calf
Layers
r ent
'10
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish—
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Co
jBoars
e
Turkeys
Tjrk— Poults
er
Dischary_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Structure E] 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 ;RNo [:] NA E] NE
E] Yes []No [DNA E] NE
E] Yes C-] No [D NA [—] NE
[:)Yes [:]No
El YeskNo
E] Yes &No
NA NE
NA NE
NA NE
Page I of 3 21412014 Continued

Facility Number: g;2= - I [Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
-7
Observed Freeboard (in): , - L-(
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
ELNo [] NA E] NE
No E] NA [3 NE
Structure 6
[3 Yes El No [-] NA [—] NE
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes
[R 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 D"
7. Do any of the structures need maintenance or improvement?
E] Yes
El No
[3 NA
E3NE
8. Do any of the structures lack adequate markers as required by the pertnit?
Yes
[K 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
54,�o
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
L241 No
NA
NE
F] Excessive Ponding 0 Hydraulic Overload E] Frozen Ground Heavy Metals
(Cu, Zn, etc.)
F] PAN E] PAN> 10% or 10 lbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge
into
Bare Soil
M Outside of Acceptable Crop Window Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diffelf0frorn those designated in the CAWMP?
E] Yes
E&No
[—] NA
[:] NE
15. Does the receiving Crop and/or land application site need improvement?
Yes
[RNo
Ej NA
F-1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
No'
NA
NE
acres determination?
_[]a
17. Does the facility lack adequate acreage for land application?
Yes
r---t No
kc�&
NA
NE
18- Is there a lack of properly operating waste application equipment?
Yes
[Q No
NA
E] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
ONo
E]NA
[3 NE
20. Does the facility fail to have all components of the CAVIMP readily available? If yes, check
0 Yes
'No
U51,
[:] NA
[:] NE
the appropriate box.
0VVUP OChecklists 0 Design E] Maps Ej Lease Agreements 00ther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. E] Yes [�q No
M Waste Application [:] Weekly Freeboard 0 Waste Analysis [:] Soil Analysis [:] Waste Transfers
E]Rainfall F1 Stocking El Crop Yield E] 120 Minute Inspections El Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E] Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes No
NA [-] NE
Weather Code
El Sludge Survey
[:] NA [:] NE
[D NA E] NE
Page 2 of 3 21412014 Condnued

Dat
lFacility Number: A2 -'�ZA/n E_e of I spection: .11-149
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes f2jNo E] NA F] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E] Yes [Z 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 No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
[] Application Field . 0 Lagoon/Storage Pond El Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAViMP?
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?
E] Yes W No E] NA [] NE
[3 Yes 4 No [:] NA E] NE
E] Yes q No [:] NA [:] NE
[3 Yes JE�No [:] NA [:] NE
[:)Yes Q No
El Yes Mv No
40q
[:]Yes EQ No
NA NE
NA NE
NA NE
(F�f�r to questi(inift.-Ex t.
p1hffij y-YES answers and/or. any.addition-allrec6inmendations or any, other-f-ep dnie—ni
C
Vz-
ji�,of faciHty to,'VFfi0r;1ii61 tsifidations(useadditional pages as;ue�ce's"s_kKrV13
7-D
Reviewer/Inspector Name:
j, f Ajo LP
-7
Phone:
Reviewer/inspector Signature:
Page 3 of 3
Date:
21412014

Date of Visit: Arrival Time: Departure Time: County
Farm Name: iyzl� r— az� Owner Email:
Owner Name: K LF� Phone:
Mailing Address:
Physical Address:
Facility Contact: r1c)--er" Title:
Onsite Representative:
Certified Operator: AL_9'zf
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude;
Region: ff-R-6
Sign,
�p3u.rren
es&&111�1 urrp
Swine
ult
cipa i
Pop-
a
Wean to Finish
W e a n
W n
Wean to Feeder
e to
-a
Layer
I jNon-Layer
I
ow
alf
Fe e r I.
Feeder to Finish
d e
eifer
w I
Farrow to Wean
0
ElBoato
F w I
Farrow to Feeder
'a
F arrow I
arrow to
Layers
D.esi n
a aci
Current
P.
Dry Cow
Non -Dairy
Beef Stocker
-inish
Ilts
Gilts
0 _s
rs
Non -Layers
Pullets
Beef Feeder
Beef 13—od Cow
Turkeys
th
Other
rurkey Poults
LjOther
t er
rrOther
T
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at- El structure Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:] Yes [X No [] NA [:] NE
Yes No NA [:] NE
Yes No NA D NE
E] Yes [:]No
El Yes J&No
[:]Yes JZ No
Ej NA NE
[:] NA NE
DNA NE
Page I of 3 21412011 Continued

[Facility Number: 9,2 jDate of Inspection: 'I, -
Waste Collection & Treatment
4. Is storage capacity (structural plus ston-n storage plus heavy rainfall) less than adequate?
E] Yes
RNo
E] NA
E] 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
F�7 No
Vs
E] NA
[D 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
E] Yes
(Q No
[:] NA
E] 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?
E3Yes
14 No
E] NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
R_,I 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
F] Yes
LnL No
NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternati ves that need
[:]Yes
1K No
NA
E3 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:] Yes J&No 0 NA E] NE
F] Excessive Ponding Ej Hydraulic Overload [:] Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
[:] PAN [D PAN> 10% or 10 lbs. E] Total Phosphorus E] Failure to Incorporate Manure/Sludge into Bare Soil
F-1 Outside of Acceptable Crop Window Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): 67/-ti / IU/, 0-7 1 / A, �-, 4--, s,�J
7-
13. Soil Type(s):
14. Do the receiving crops Aer from those designated in the CAWMP?
0 Yes
[KNo
E] NA
El 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/01' operate per the irrigation design or wettable
Yes
No
NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
No
NA
NE
18. Is there a lack of properly operating waste application equipment?
Yes
No
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
No
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
C? No
E] NA
0 NE
the appropriate box.
E3WUP [:]Checklists Ej Design Ej Maps 0 Lease Agreements [:] Other:
2 1. Does record keeping need improvement? If yes, check the appropli ate box below. E] Yes J�f No 0 NA E] NE
E:1 Waste Application [] Weekly Freeboard ED Waste Analysis [:] Soil Analysis E] Waste Transfers [:] Weather Code
r_1 Rainfall E] Stocking [:]Crop Yield E] 120 Minute Inspections E] Monthly and I " Rainfall Inspections [:1 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—] Yes EANo C] NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Ej Yes B-No [] NA [:] NE
Page 2 of 3 21412011 Continued

[Facility Number: Fpiat� of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes Pq No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E] Yes Dq� No
the appropriate box(es) below.
Ej 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?
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application Field 0 Lagoon/Storage Pond E] 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
[] Yes
[RNo
NA
E] NE
[:]Yes
CZ No
NA
E] NE
0 Yes M No E] NA E] NE
E] Yes OLNo F] NA F] NE
F] Yes [2g No E] NA [D NE
E] Yes rOl No E] NA C] NE
L-04
[]Yes allo
Yes 54 No
Yes J&No
NA NE
NA NE
[DNA NE
M�MiFntsm(fef&.40�'il'b6tion Explain any YES,answers. and/or,,any additional recommendation— th ' corn"'m"e-iiCE
F K ar[K.M. _er'
.. . .. . ....
dlifWo better explain situations e7idditional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: kj�L'�—
Date: if/
21412017

Type of Visit: &Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: alro'utine C) Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Tr� ArrivalTime: Departure Time: County:
Farina Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �21 lolw-e— Title:
Onsite Representative:
Certified Operator: rn9 IC
Back-up Operator:
Location of Farina:
Latitude:
Phone:
Integrator: ZW641
Certification Number:
Certification Number:
Longitude:
Region:
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? Yes 0 No [:] NA El NE
Discharge originated at: E] Structure f__j Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes No NA NE
[] Yes No NA NE
C] Yes
E] No
[:] NA
NE
CD Yes
[R No
E] NA
NE
Yes
PUI No
V::�_
[—] NA
NE
Page I of 3 21412011 Continued

"', 10, "
Facility Number: [Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes [5j No NA ONE
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 N No 0 NA 0 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 JR 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 DWQ
7. Do any of the structures need maintenance or improvement?
OYes
MNo
[DNA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
No
NA
NIE
(not applicable to roofed pits, dry stacks, and/or Wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
No
NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
[3 No
E] NA
ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
El Yes
CFI -No
[—] NA
[:] NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground Ej Heavy Metals
(Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): aLav—^_
14. Do the receiving cropidiffff from those designated in the CAWMP?
Yes
[a No
0 NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
allo
0 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
ONo
0 NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
M No
0 NA
0 NE
18. Is there a lack of properly operating waste application equipment?
Yes
0 No
NA
NE
Required Records & Documents
19. Did the facility fail to have the 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
0 Yes
allo
NA
NE
the appropriate box.
OWUP LjChecklists [:]Design [:]Maps 0 Lease Agreements OOther:
21 . Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [a No
El Waste Application 0 Weekly Freeboard 0 Waste Analysis ED Soil Analysis E-] Waste Transfers
n Rainfall 0 StockingE:]CropYield [J]20 Minute Inspections Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes [��No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yesallo
NA [:] NE
Weather Code
Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? OYes ta No NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [:] No NA NE
the appropriate box(es) below.
F� Failure to complete annual sludge survey Failure to develop a POA for sludge I evels
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? 0 Yes 0 No E] NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes MV No 0 NA NE
&104
OtherIssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes Mt No NA [:] NE
Unbk
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 [4 No NA ONE
If yes, contact a regiona� Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the Yes J� No NA [:] NE
permit? (i.e., discharge, fireeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes No NA [:] NE
[j Application Field [:] Lagoon/Storage Pond [D Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes No NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes MV No 0 NA 0 NE
Reviewer/Jnspector Name: 12�1&= Phone: 9/p_'Oa-3�Foo
Reviewer/Inspector Signature: Date: 1-3
Page 3 of 3 21412011

;AP /.—.—
IType of Visit: (9lUompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q<oudne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: �jezLei, e!y� Phone:
Mafflng Address:
Physical Address:
Facility Contact: A7r�/- Title: Phone:
Onsite Representative: Integrator: jwCzeffl11Z
Certified Operator: Certification Number:
Back-up Operator: Certification Number -
Location of Farm:
Latitude.
Longitude:
Region:
E Sl �urrent Design Gurrent
ult a UPI an ba aci P
Wean to Finish ow
Wean to Feeder
Feeder to Finish
er
alf
cifer
Farrow to Wean
Dry Cow
Farrow to Feeder
It.
Non -Da'
I lFarrow to Finish
I
I
LMers
Beef Stocker
!"Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
[�oar�s
Pullets
Turkeys
e
Turkey Poults
Other
Dischar2es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure E] 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 reac'hed waters of the State (gallons)?
Yes F2 No E] NA E3NE
W.-r
F] Yes E] No F] NA E] NE
E] Yes Ej No E] NA El NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) Yes E] No NA NE
2. Is there evidence of a past discharge from any part of the operation? Yes CK No NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ED Yes 5?[ No F] NA Ej NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

lFacility Number: 4Z) FDatewflinispection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? E] Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): L2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No NA NE
No NA NE
Structure 6
[:] Yes Ig No E3NA [:] NE
6. Are there structures on -site which are not properly addressed and/or managed through a
E] Yes
�K 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
[�j No
NA
[:] NE
8. Do any of the structures lack adequate markers as required by the permit?
E] Yes
0 No
NA
0 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
Ej Yes
0 No
Ej NA
E] 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
Ej NE
Excessive Ponding 0 Hydraulic Overload E] Frozen Ground [:] Heavy Metals (Cu, Zn, etc.)
PAN [-] PAN > 10% or 10 lbs. E3TotaI Phosphor -us E] 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 crop4giffer fromthose 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
E] 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
L�J_No
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
El Yes
2 No
El 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.
RWUP [DCheeklists 0 Design [:] Maps E31-ease Agreements 00ther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below, [-] Yes allo
Waste Application E] Weekly Freeboard E:1 Waste Analysis E] Soil Analysis E] Waste Transfers
Rainfall E] Stocking Ej Crop Yield E] 120 Minute inspections Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? Yes No
6al
NA [-] NE
Weather Code
E] Sludge Survey
NA NE
NA NE
Page 2 of 3 21412011 Continued

lFacility Number: Date of Inspection. �� —Z.;k-
24. Did the facility fail to calibrate waste application equipment as required by the permit? F NA NE
] Yes rv4 No F
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check F[Yes NA NE
the appropriate box(es) below.
E] Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
[,RNon-compliant sludge levels in any lagoon
, List structure(s) and date of first survey indicating non-compliance: mal
26. Did the facility fail to provide documentation of an actively certified operator in charge? C] Yes allo E] NA [:] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes Eg No C] NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 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?
E] Yes M No C] NA L] NE
Lc�hk
Yes r_j No 0 NA [:] NE
L2r.L
[:] Yes q No [:] NA [:] NE
Yes
M No
E] NA
E] NE
Yes
Wi No
[:] NA
E] NE
[D Yes
ELNo
E] NA
E] NE
0 Yes
Eg-No
[:] NA
[:] N-E
IComments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facitity to better explain' situations (use additional pages as necessary). I
b_C7 C� , , 1:7-- -4— r f �e _--b — ,
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 5;1 -7
21412011

Type of Visit: Q'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Woutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County-_Z14...
Farm Narne xz-77'-/- )1-5�"I_' Owner Email:
'9 54 xx
Owner Name: a,-,- � X -., Phone:
Mailing Address:
Physical Address:
Facility Contact: &rtfe-"-- a
Title: Phone:
Onsite Representative: Integrator: 'Oz�' 60el-
#I /
Certified Operator: Certification Number -
Back -up Operator: Certification Number:
Location of Farm:
Latitude:
Discharims and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge origin ated at: D Structure [] Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the Operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region: 0
Yes
M�o
&A —
[:] NA
NE
Yes
D No
DNA
NE
Yes
D No
D NA
NE
Yes
[:] No
NA
D NE
Yes
[&No
NA
E] NE
C] Yes
gj,No
DNA
D NE
Page I of 3 21412011 Condnued

lFacility Number: jF�_ --&//
,,, ir I I Date of Inspection:
Waste Collection & Treatment
1 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 FreeboaTd (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes JR No 0 NA 0 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
OYes
gNo
ONA
ONE
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?
[a Yes
0 No
NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
E] No
NA
0 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
E] Yes
0 No
0 NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
OYes
n No
0 NA
0 NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes
B_No
[—] NA
[:] NE
Excessive Ponding [:] Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
PAN [:] PAN > 10% or 10 lbs. Total Phosphorus 0 Failure to Incorporate Manure/Sludge
into Bare Soil
Outside of Acceptable C Wi dow [:]Evidence of Wind Drijft 0 Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving cro4/differ from those desigb/ated in the CAWMP?
Yes
0,N o
NA
NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
RNo
NA
NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
E] Yes
RA No
0 NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
No
%0­%.
C-] NA
NE
18. Is there a lack of properly operating waste application equipment?
Yes
No
0 NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
Callo
0 NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check E] Yes
EEI'No
[:] NA
0 NE
the appropriate box.
EIWUP OChecklists [:] Design 0 Maps 0 Lease Agreements 0 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—] Yes [R.No
Waste Application 0 Weekly Freeboard [:] Waste Analysis [:] Soil Analysis F] Waste Transfers
Rainfall OStockingO Crop Yield 0 120 Minute Inspections 0 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? E] Yes Q�LNo
NA 0 NE
Weather Code
0 Sludge Survey
NA 0 NE
NA 0 NE
Page 2 of 3 21412011 Continued

JlFacility Number: 7ZO'77 I Date of Inspection: �
g!�12 I '�
24, Did the facility fail to calibrate waste application equipment as required by the permit? F] Yes CZ�No [] NA F] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Q Yes WNo E3NA [] NE
the appropriate box(cs) below.
C] Failure to complete annual sludge survey EjFailure to develop a POA for sludge levels
ONon-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? E] Yes E& No E] NA E3NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? C] Yes fA No E] NA E] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i:e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Ej Application Field 0 Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/InspeCtOT fail to discuss Teview/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ELNo [] NA [:] NE
F] Yes MNo [] NA [:] NE
[:]Yes allo Ej NA [] NE
Yes
MNo
NA
C3 NE
Yes
allo
NA
[] NE
Yes
[�gNo
E] NA
E] NE
Ej Yes
M No
11�
E] NA
C] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facifity to better explain situations (use additional palzes as necessarv). I
6;
7F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit &'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit PrIGutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: � County: 15�; �,P­ Region.
A�v
Farm Name: Owner Email -
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 12144_0�1_ . Title: 6_.!yA*yf__ Phone No:
Onsite Representative: Integrator: e /
Certified Operator: _*5—if— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F­1 0 = ( = " Longitude: =0[=t =61
Zbol
ien
u;
iult
'Trm
W e a n to Fini
an to Finish
11:1 Layer
El Dairy Cow
W e a n to Feeder
to Fee'
[[:]_Non -Layer
El Dairy Calf I
Wan
Fe�eder to Finish
E F e er to I
rrow to
E317arrow to Wean
E3Fa W
OFarrow to Feeder
E] Farrow to Fe
El Dairy Heifer
[-I Dry Cow
El Non-Dai ry
El Beef Stocker
El Beef Feeder
El Beef Brood CA
um e 5"ptures:
EdF
Farrow to Finish
O3 r ow to il
ElLayers
El Non -Layers
Gilts
PE3E3 I s
E3 Boars
El Pullets
F1 Turkevs
ED] urkey Poultsl
otl
FE-3Other
10 Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure 0 Application Field F-1 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?
0 Yes allo El NA 0 NE
[:1 Yes
El No
[I NA
[I NE
E] Yes
El No
N A
N E
NA
NE
El Yes
[-I No
E] Yes
JX No
NA
NE
[I Yes
SNo
El NA
D NE
Page I of 3 12128104 Continued

[Facility Number:& Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes Z[No El NA El NE
a. If yes, is waste level into the structural fireeboard? 0 Yes [I No El NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 91
Observed Freeboard (in): 3' �?
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes M 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 El Yes fA No [:1 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? ER Yes Rfro El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 59 No El 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 E]Yes allo [I NA El NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes U�No EINA El NE
maintenance/improvement'?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. E]Yes &SNo EINA ONE
Excessive Ponding El Hydraulic Overload D Frozen Ground E]Hcavy Metals (Cu, Zn, etc.)
EIPAN EIPAN>10%orl0lbs E]Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window El Evidetic�e of Wind Drift E] Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[I Yes
KNo
El NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
El yes
2kNo
EINA
11 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
a No
El NA
0 NE
17. Does the facility lack adequate acreage for land application?
El Yes
OLNo
El NA
0 NE
18. Is there a lack of properly operating waste application equipment?
E] Yes
E?LNo
[j NA
[j NE
�Coniments.(tefer to qu0stiofi'#):!Explain any S-a s r.any
YF n wers.and/ ­_.o cripo
ra m
da
wings�gffaciHty,-to-beii�r�-,�iMii situations.:(u 'additionaI2� Re!
­� r 0�m
se qges n s
r.4
Phone- 2eC
Reviewerlinspector Name
Reviewer/Inspector Signature: Date:
Page 2 oj 3

Facility Number.
Date of Inspection 11/0—'7-7t�zp
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 5LNo D NA [I NE
20. Does the facility fail to have at] components of the CAWMP readily available? If yes, check 0 Yes Da No D NA El NE
the appropriate box. El WUP D Checklists El Design El Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:1 Yes 04 No El NA [:1 NE
El Waste Application El Weekly FTeeboard D Waste Analysis El Soil Analysis El Waste Transfers D Armual Certification
0 Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and I " Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? D Yes E No 0 NA [:1 NE
21 If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? D Yes V'4 No 0 NA [:1 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[Z No
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
Elyes
F[No
DNA
EINE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
(3 No
El NA
0 NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
[j NA D NE
Otherissues
28. Were any additional problems noted which cause non-compliance of the permit Or CAWMP?
Yes
10 No
El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
XNo
El NA [:1 NE
and report the mor-tality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
KNo
D NA El NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
LRNo
D NA [:1 NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
EJ-No
(__1 NA [:1 NE
33. Does facility require a follow-up visit by same agency?
E] Yes
Callo
D NA [:1 NE
Page 3 of 3 12128104

182-
�QthirA
Type Of Visit EPI[rompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9- �Gna 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Dale of Visit: ArrivalTime- Departure Time: Countv- Region:
Farm Name: Nq-* &4_44e4l �Cavlll Owner Entail:
Owner Nmne- C�N' Phone:
Mailing Address,
Physical Address:
Facilitv Contact: A4cr6 re --
-Title: Phone No:
On%iteRepresentalive. Gr-et_v— Integrator: 0-01,J A/
Certified Operator: Operaioi-Certific-alionNunit)er- 2-496337
Back-up Oper-itor-
Location or Farm:
Swine
El Wean to Finish
I
I
Wean to Feeder
1-6-40 0
Feeder to Finish
0 Farrow to Wean
0 Farrow to Feeder
El Farrow to Finish
0 Gilts
El Boars
Other
La Other
Back -tip Certification Number:
Latitude: Longitude:
=o=,
Design Current Design Current
Capacity Population WetPoultry Capacity Population
[I Layer I -::� —d
10 Non -Layer I I
Dry Poultry
0 Layers
0 Non -Layers
Pullets
Turk!ys
urkey Poults
JELOther
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure El Application Field 0 Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
[I Dairy Calf
I -A
El Dairy Heifer
0 Dry Cow
El Non -Dairy
0 Beef Stocker
0 Beef Feeder
0 Beef Brood Cow]
Number of Structures: EKI
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?
0 Yes ETN�o El NA 0 NE
F1 Yes
0 No 2lqA
0 NE
0 Yes
0 No 914'A�
0 NE
E
I
0 No EFIIA'�
ONE
0 Yes
0 Yes
CW.' 0 NA
El NE'
El Yes
9-Ko'C] NA
0 NE
12128104 Condnued

Facility Number: 82-- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
EJ/No [I NA El NE
a. If yes, is waste level into the structural freeboard?
D Yes
El'N'o El NA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
identifier: t
Spillway?:
Designed Freeboard (in)�
Observed Freeboard (in): 3o
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
0<o El NA 0 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
0 Yes
ErNo El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
eNo [-I NA D NE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
CT`N�o [:1 NA El 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
El Yes
B<o [I NA [:1 NE
maintenance or improvement?
Waste Application
'No
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
Z [I NA 0 NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below,
El Yes
E�No El NA [:1 NE
[I Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[I PAN El PAN > 10% or 10 lbs E] Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window [I Evidence of Wind Drift [I Application Outside
of Area
12. Crop type(s) KAFY 0'.;W eo
13. Soil type(s)
14- Do the receiving crops differ from those desi&mated in the CAWMP?
El Yes
EK0
El NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Q<o
El NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design Or wettable acre deten-nination ?
C3 Yes
9-No
El NA
El NE
17- Does the facility lack adequate acreage for land application?
0 Yes
[3<o
El NA
NE
18. Is there a tack of properly operating waste application equipment?
0 Yes
O<o
[:1 NA
NE
gr
hN.-(r"fFrot6'qd8ti6n#.): Ex'0laih'anyWE_SP'ins eN;an cinauvrecommNA mme
2111s, rranvZothe co
X -
.Use dra . win s f 1i`sVus4r;4d!W4n-al' I
Gc
9 �to better explain A tuatio
Reviewer/Inspector Name
�R am Phone: -
Reviewer/Inspector Signature: ?09F� Date: 12 - &'7 — Zio qu
12128104 Continued

12 -07
rFacility Number: R2 —2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. MWTTP nna.� r1KA � FIC)th,-,
5- -11
E]Yes [BNo El NA El NE
El Yes BNo El NA El NE
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
U Yes
U NA
LJ NE
Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis El Waste Transfers
0 Annual Certification
El Rainfall El Stocking El Crop Yield 0 120 Minute Inspections [:1 Monthly and I
Rain Inspections El
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
2No
[I NA
NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
EJNo
El NA
NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
EI'No
El NA
[D NE
25- Did the facility fail to conduct a sludge survey as required by the permit?
[:3 Yes
BIN'o
El NA
[] NE
26. Did the facility fail to have an actively certified operator in charge?
0 Yes
ErNo
[:1 NA
0 NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
ET'No
El NA
[:) NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAVRVIP?
Yes
[?(No
[:1 NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
B<o
El NA F1 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
21�o
El NA ED NE
Ifyes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office ofemergency situations as required by
El Yes
OB/No
El NA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
E]Yes
53rNo
EINA ONE
33. Does facility require a follow-up visit by same agency?
El Yes
O"No
[I NA El NE
12128104

13io-,s /-o S -oq Rlz—
Type of Visit ['!'Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 9PITo-utine Q Complaint 0 Follow up Q Referral Q Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: , — OW Departure Time: %1 County: Region:
Farm Name: NLLA IA411g r LeAV I.% Owner Email:
Owner Name: �M44- RU4ls' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: C r x-y- Kkao r c— Integrator: =�;U . '
Certified Operator: Za S- la 1A A Ir (r.14.17) Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f 0 u Longitude: = ° [= l = "
III
5_w�n e
Des►gnCurrent
a ultry
Ccrty Population, Wet Po
_
g + " g Current
DestrnCurrent _ Cattle Desi n
Cap cityPopulation ° Capacity Population
❑ Dairy Cow
❑ Wean to Finish � ❑ Layer
can to Feeder
❑ Non -La er
El DairyCalf
❑ Feeder to Finish
�, ❑ Dairy Heifer
❑ Farrow to Wean
❑
Dry Poultry
" A" x ❑ D Cow
Ef
A.
` s
Farrow to Feeder
❑Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
12
❑ Beef Brood Co
Other
❑ Other
�
�
� Nur+tber of Structures• Z,
El Non -Layers
El Pullets
❑ Turkeys
❑ Turke Poults
Other ❑
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
B<o
El NA
[I NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
El No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
D<A
❑ 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
[R'IlA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[3 Yes
Flo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
��
El NA
❑ NE
other than from a discharge?
Page I of 3
11/28104
Continued

I Facility Number:.IT?- -
Date of Inspection Ft 2-- _07-- -6-1-Rl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ss� I
Spillway?:
Designed Freeboard (in): . 114 I-,c.,, =AA
Observed FreeboaTd (in). I&.,
5. A -re there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
[I Yes ffN"o [:] NA 0 NE
0 Yes D'K'.F-1 NA [] NE
Structure 5 Structure 6
[3Yes 2<o [:INA ONE
[]Yes EJ'No [--INA EJNE
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? E]Yes BN'o [3 NA ONE
8. Do any of the stuctures lack adequate markers as required by the permit? [3 Yes ERNo 0 NA El 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 0Yes B<o"EINA [:INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ETNo 0 NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. [:3 Yes P<o 0 NA El NE
0 Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
OPAN EIPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind brift DApplication Outside of Area
12. Crop type(s) (L-k!n'� " Z7. a h.;', )
13. Soil type(s) — U3 &IR
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
ErNo
E] NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
ET'No
El NA
[:1 NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre deten-nination?[D Yes
B<o
[3 NA
El NE
17. Does the facility lack adequate acreage for land application?
D yes
2<
[] NA
El NE
18. Is there a lack of properly operating waste application equipment?
[3 Yes
[R<o
[I NA
El NE
Reviewer/Inspector Name I R."
Reviewer/Inspector Signature: ,
Phone: Ctit). 5'33.333o
Date: /2 -0.9-2609
Page 2 of 3
12128104 Continued

Facility Number: FZ —2/91 Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? [:1 Yes Ejl�o El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check E]Yes ET5o El NA [I NE
the appropirate box. [:1 WUP [I Checklists [] Design D Maps [:1 Other
21, Does record keeping need improvement? If yes, check the appropriate box below. El Yes EK_ El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
EIRainfall ElStocking E]CropYield 0 120 Minute Inspections El Monthly and I" Rain Inspections E]WeatherCode
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
P<o
El NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irfigation equipment?
El Yes
Ealro_
El NA
[:1 NE
24-
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
E�-<o
[I NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
Ez�<o
El NA
[:3 NE
26.
Did the facility fail to have an actively certified operator in charge?
[:1 Yes
G<o
[__1 NA
[:1 NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
3<6
El NA
El NE
Otherlssues.
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:1 Yes
D-No-
[__1 NA
El NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
El Yes
[3-<o
El NA
0 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?
ED Yes
0<_
ED NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
E] Yes
CIH<o'
0 NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 yes
GKo_
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
E<o — Ej NA
El NE
w ngs:
Page 3 of 3 12128104

Type of Visit Ilptcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. p Arrival Time: Departure Time: County. s� Region:
Farm Name: I . "' / Owner Emaff
Owner Name: ' l —0-ro-a � Q'1�1 (M Phone:
Mailing Address:
Physical Address`:�[
Facility Contact: �+ & 0.AJTitle:
Onsite Representative:
Certified Operator: In rR-
Back-up Operator:
DW b-I Phone No:
PIntegrator: �
Operator Certification Number: a``�
o�
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 & =6. Longitude: = o = 1
Design Current Design
Curren °Y Design Current
Swine Capacity Population Wet Poultry Capacity
Population - s tittle Capacity Population
Wean to Finish
I ❑ La er
El
Cow
Wean to Feeder
❑ Non -La er
= ❑ Dairy Calf
El Dairy Heifer
ElFeeder to Finish
ElFarrow to Wean Dry Pottltry
w ❑ Da Cow
ElFarrow to Feeder
�F�
ElNon-Dairy
El Farrow Farrow to Finish ❑
; El Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
❑ Pullets
❑ Boars es
ElBeef Brood Cowl I
El Turkeys
Other El
�,_.
VY .
Turkey Poults
-'. Number of 5truetures: �- -
FET Other ❑ Other
Discharges & Stream Im acts
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�rNA
❑ 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
PA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes PNo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ARbNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

racility Number -IS Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes_/1,L'I0 0 NA [3 NE
a. If yes, is waste level into the structural freeboard? El Yes A No El NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structu 0 El Yes V�No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes )kNo El NA El 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? Ej Yes P No [] NA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes )11No El NA [I 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 Dyes -ldh No 0 NA E] NE
maintenance Or improvement? qN
Waste Avolication
10. Are there any required bUffCTS, setbacks, or compliance alternatives that need Ej Yes XNo EINA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 0 No 0 NA El NE
0 Excessive Ponding El Hydraulic Overload [:1 Frozen Ground El I-Ieavy Metals (Cu, Zn, etc.)
E]PAN E1PAN>10%orl0lbs E]Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
MKI
14. Do the receiving crops differ rom those designated in the CAWMP?
El Yes
_9��
[j NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
& No
El NA
El NE
16. Did the facility fail to secure andior operate per the irrigation design or wettable acre determination?[] Yes
RNo.
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
'X No
[:1 NA
C1 NE
18. Is there a lack of properly operating waste application equipment?
El Yes
��o
El NA
11 NE
Comments (refer to question #): Explain any VES answers and/or any recommendations or any other comments.
Use drawings of facility to bet -ter explain situations. (use additional pages as necessary): I
Reviewer/Inspector Name I NT01V Phone:
Re-dewerlinspector Signature: C_ka AAQ Date:
124,
Continued

Facility Number."& Date of Inspection
Required Records & Documents
19- Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes *KNo [INA El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check El Yes *14 No 0 NA [__1 NE
the appropriate box. El wup El Checklists El Design 0 Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes ONo
[:1 NA El NE
El Waste Application 0 Weekly Freeboard [:1 Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
EIRainfall ElStocking E]CropYield El 120 Minute Inspections E] Monthly and I" Rain Inspections E]WeatherCode
22. Did the facility fail to install and maintain a rain gauge? El Yes brNo El NA C3 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes El No 'ONA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ';&No I--] NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? 0 Yes "KNo El NA El NE
26, Did the facility fail to have an actively certified operator in charge? El Yes 54 No El NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No J�j NA El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes P No El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [jYes "��No [:] NA El 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? El Yes )KNo El NA El NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by L1 Yes A No E] NA El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Ej Yes )q No [:] NA [:1 NE
33. Does facility require a follow-up visit by same agency? 1-9i—Yes rNo [:1 NA El NE
Additional Comments and/or Drawings:
4un&�&ov) o-n Lto v x c
5rrUAk Ot'M av�� z4v t
A 0 4 a5 S 44ALLn
O_k� ( /_ 10
rLAn 0
A
'r (X', V�
7;
0.,) q : ,, :� 0 daLAt
Page 3 of 3 12129104

Facility No. !�po Time In /0 Time Out Date
Farm Name Integrator
Owner Site Rep
Operator No. - AW
Back-up No.
COC Circle: �enjeral or NPDES
- Design
Current
Design
Current
�Wean -Feec-�o
G
Farrow - Feed
VVe—a-6--71-nish
Farrow - Finish
Feed, Finish
Gifts / Boars
Farrow - Wean
Others
FREEBOARD: Design
%G;Lidge Sluniey - .,— -f ( 0
Crop Yield
Rain Gauge
Soil Test PLAT
Observed
Calibratior!GPM
Waste Transfers
Rain Breaker
Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop 41 �-f I r� � 11
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
-Uht
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
oe A P
:27�; YvlcL( — U 6f
v, -I IT Y�

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance
Reason for Visit W Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: F977M Departure Time: County: Region
Farm Name: r Qt'� �► m Owner Email:
Owner Name: �� Qu do Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone No:
Onsite Representative: Integrator:
Certified Operator %n'� 4L< ;r 4u`yly� Operator Certification Number: oms�n
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 O E=I ' E=1 " Longitude: 0 ° = 6 =
r-_; .5r,da. S (F_ 13 0(" j os 1233 eov, u v : i)e .eu SoAu,6r�, •
71C*-, S 0-130 4 Y'+ en • N� S tt: r 3 t 8
U
Design Current
Swine Capacity Population Wet'Poultry
Design
Capacity
Current
Population
_ Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dal Cow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
El Beef Brood Co
Wean to Feeder
-
Layer
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
D'ry'Poultry
❑ La ers
❑ Farrow to Finish
El Non -Layers
❑ Gilts
El Pull
❑ Boars
ts
Turkee s
Discharges & Stream Im acts
. Is any discharge observed from any part of the operation? El Yes XNo ❑ NA ❑ NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made? El Yes El No RNA [I NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) El Yes El 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 El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes Xo El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes �No El NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number-5D,
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 0
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
0 Yes No El NA D NE
El Yes No [:1 NA [:1 NE
Structure 5 Structure 6
El Yes KNo El NA [:1 NE
0 Yes )�q No El NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes NVNo El NA D NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes XNo 0 NA El 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 El Yes A No Cl NA [j NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
El Yes V*o 0 NA El NIE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes WNo D NA [:1 NE
D Excessive Ponding D Hydraulic Overload El Frozen Ground D Heavy Metals (Cu, Zn, etc.)
EIPAN EIPAN>10%orl0lbs 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[_1 Yes
ANo
Ej NA
L1 NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
Wo
0 NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
0 Yes
* No
(] NA
El NE
17. Does the facility lack adequate acreage for land application?
[:1 Yes
ZVo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
D Yes
K7No
DNA
EINE
�4j: Explain any YFS answers andVor any recommendations or any other coma6
0 ques�6 mi-en
r
CUSZ cility'to-,bett�r explain situations. (use additional pages iisnecessary):
Reviewer/Inspector Name Phone: 33 3�5
Reviewer/Inspector Signature: Date: -:J—L>nt
I 6=tA
Page 2 of 3 12128104 Continued

Facility Number:�I� —�Zftj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes �(N. 0 NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. 0 WUP 0 Checklists ODesign El Maps 0 Other El Yes [�PNo 0 NA El NE
21. Does record keeping need improvement? If yes, check the appropriate box below. Oycs '*V No El NA [__1 NE
0 Waste Application 0 Weekly Freeboard El Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
DRainfau E]Stocking E]CropYield El 120 Minute Inspections 0 Monthly and V Rain Inspections OWeatherCode
22.
Did the facility fail to install and maintain a rain gauge?
El Yes 'EgNo
ONA
ONE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes El No
0 NA )R�IE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes 0 No
NNA
0 NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes El No
'% NA
0 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes ' B�No
Ej NA
0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes [] No
V NA
[:1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes _jXNo
0 NA
E] NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes 5�No
EINA
El 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?
0 Yes b�No_O NA
El 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
El Yes JkNo
El NA
0 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site repreSentative?
El Yes qNo
[:1 NA
0 NE
33.
Does facility require a follow-up visit by same agency?
[I Yes 0 No
El NA
0 NE
kddiiio6al Comments and/6r Dr'6w�''*i�'
Q 1
3zx�
Page 3 of 3 12128104

t I
-rype of Visit 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation () 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: Departure Time: County: _—�a&W_Ana Region:
Farm Name: prdt"qAyd A.-C-22 Owner Email:
_f — F..' � 01W &C
Owner Name: 06;&. _42r'a Phone:
MailingAddress: _34 -Ae #v& La log Ale -
.a 7- .29
Physical Address:
Facility Contact: —Title:
0 nsite Representative: 3-eapim e- 91f &ela4 40"
yma %IF
Certified Operator:
Back-up Operator:
"01we
Phone No: - cf /0 - S-6 Af --R 3 V Y
Integrator: A-eAn;fom _S&4524_�
Operator Certification Number: -20937
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I = 11 Longitude: = 0 =I = "
Swine
10 Wean to Finish
12-Wean to Feeder
6-600
13.200
El Feeder to Finish
El Farrow to Wean
D Farrow to Feeder
El Farrow to Finish
El Gilts
1:1 Boars
Other
[E] Other
Design - Current Design Current
Capacity Population Wet Poultry Capacity PopuWi.on
P Layer
EE] Non -Layer
,-. __ — - — 7
Dry Poultry
El Layers
El Non -Layers
Pullets
El Turkeys
ED urkey Poults
10 Other
Discharges Sz Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at-. El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Populaflon
El Daia Cow
El Daia Calf
I
El Dairy Heifei
0 Dry Cow
El Non -Dairy
El Beef Stocket
El Beef Feeder
0 Beef Brood Cowl
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)?
Number of Structures: Ell
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?
1:1 Yes 2No Ej NA El NE
El Yes
[:3 No
El NA
El NE
D Yes
[I No
0 NA
El NE
[_1 NA
El NE
El Yes
[:I No
0 Yes
2<o
[j NA
El NE
[:1 Yes
Q<o
El NA
0 NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
gk&o
0 NA
[] NE
a. If yes, is waste level into the structural fTeeboard?
0 Yes
D No
E] NA
[:1 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;;Z
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
M-Ko
[I NA
ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
[0-Ko
0 NA
El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
�o
El NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
��o
[:1 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
0 Yes
2Ko
El NA El NE
maintenance or improvement?
Waste Application
10- Are there any required buffers., setbacks, or compliance alternatives that need
El Yes
[Xo
El NA El NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
�o
0 NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
EIPAN El PAN> 10%or 10lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of
Area
2 -7;-
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
2f-;o
0 NA [] NE
15. Does the receiving crop and/or land application site need improvement?
0 yes
[iKo
El NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,E]
Yes
&20No
El NA 0 NE
17. Does the facility lack adequate acreage for land application?
[:1 Yes
2No
[:1 NA Lrj NE
18. Is there a lack of properly operating waste application equipment?
El Yes
2rNo
El NA [I NE
Reviewer/Inspector Name iz I POKE W M Phone: Wa - &EV cgj�173,o
ReviewertInspector Signature: Date: ? - At- or I
It -11-10IU4 I-o"Tifluea

Facilitv Number: 9.2 -.2/8 1 Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? 901yes El No El NA [:1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check El Yes ONo El NA El NE
the appropirate box. 0>.,ef Eluu-��s El>ngn El;j<.s ElDt+ffr�
21. Does record keeping need improvement? tf yes. check the appropriate box below. R'Yes El No El NA 0 NE
10 —:0 .7. 0 0-1 C- ->P- 07 0'-.73'
ysis
a�pplfication OWeekir44zt-b�1 EIS sis 0 Yi,
rs El Annual Centlindoi
Q�2'1_20 Minute Inspections 0 Nj2n��Rain­lnspections Ll %U�o �e
22.
Did the facility fail to install and maintain a rain gauge?
0 Yes
ETNo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El No
BN'A
[] NF
24.
Did the facility fail to calibrate waste application equipment as required by the permit'!
19-Ves
El No
0 NA
0 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
D-1y" es
0 No
El NA
[] NE
26.
Did the facility fail to have an actively certified operator in charge?
E] Yes
[91<o
El NA
0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'.)
El Yes
El No
[3<A
0 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:1 Yes
UNo
[__1 NA
[] NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El xes
E;,Ko
El NA
El 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
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
Yes
[��'No
NA
NE
General Permit? (le/ discharge. freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss re view/ inspection with an on -site representative?
Yes
��o
NA
NE
33.
Does facility require a follow-up visit by same agency?
Yes
,erNo
F
El NA
[:1 NE
Xdditinnal Comments and/or Drawings:
'01fes
-OW. —.Ile
AW)
rer vn6 )(pis TX e 'r-
0.", "/ 0/'.� I
ffev,'eemr&� r"*,Il Sol s c,., bes w ee c1d,, g
Ple OS e jr
'4A
e /J 0
Amve A, I ked
e a
or
Ne s&.1, 0'r", �75
rAt'j -9e �Ae
------ A/'b 17A
12128104

Type of Visit QrCompliance inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Gr/Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date or visit: i o Time:
Q Not Operational O Below Threshold
R(Permitted [TCertified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ..- W.. .. ..
Farm Name:_�-----
f`Qtrr+-----------------�.................._..._....�.--------- County: _ ........................................_..._..._ ........_....�......
Owner Name:... _._.........'. . . ......, Phone No: s( -
Mailing Address: `}o -r K, .... Ave .
Facility Contact: .._�!+�`---� ��_.� �.__Title:Phone No:
Onsite Representative:........................................................................................ Integrator:. 3 -' e!.r
Certified Operator Certification Number:—..--. .....�..
Location of Farm:
�E
Erswine ❑ poultry ❑ Cattle ❑ horse Latitude Longitude �• �` �"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [940
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q-Ko
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: _....�............... .......................... ..... .............................
Freeboard (inches):
12112103
❑ Yes L.o
Structure 5 Structure 6
Continued

[Fad* Number: %,2 — 9
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintcnancetunprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
Excessive Ponding 0 PAN [:] Hydraulic Overload El Frozen Ground [] Copper and/or Zinc
12. Crop type M'a 11 4CAt - IV%
13. Do the receiving crops differ with those c4esignated in the Certified Animal Waste Management Plan (CAWNIP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt�
C� Z�
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
0 Yes BIN"'o
0 Yes RNo
• Yes Ej�No
• Yes 2'N'o
El Yes YNo
0 Yes 9'No
0 Yes ErNo
0 Yes BNo
El Yes D&o
0 Yes Of4o
U Yes B"No
El Yes 2f4o
D Yes Dilfo
0 Yes fff4o
El Yes Eallo
El Yes MNo
El Yes RNo
�tjse amwWgs,01--tacinty,to"tKaw� ISM'Situtlon&,;(Use:arlftiu0mmipa ecessar
ges'as n Vfn ffFieldCopy OFinalNotes
A Nit,
eA� 6-,
NOS 45.
a ew I
-7
Reviewer/Inspector Name
Reviewer/Inspector Signature: ICU Date: +13bTV4
1,2112103 Continued

Facility Number: Date of Inspection FtT!
Reciuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
0 Yes
[9140
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
[I Yes
2-No
23. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
2No
0 Waste Application 0 Freeboard 0 Waste Analysis 0 Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes
BeNO"o'
25. Did the facility fail to have a actively certified operator in charge?
0 Yes
Mdqo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
0
Kkfio
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
96o
28. Does facility require a follow-up visit by same agency?
0 Yes
B<_
29. Were any additional problems noted which cause noncompliance of the Certified AWMI"?
0 Yes
0<0
KFDES Perndtted Facilities
30- Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
El Yes
101�0
31. If selected, did the facility fafl to install and maintain rainbreakers on irrigation equipment?
[] Yes
0 No
32. Did the facility fail to install and maintain a rain gauge?
0 Yes
0 No
31 Did die facility fail to conduct an annual sludge survey?
0 Yes
0 No
34. Did the facility fO to calibrate waste application equipment?
0 Yes
0 No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 Yes
0 No
OStockingForm OCropYieldForm ORainfall 0 Inspection After I" Rain
12112103

.9, 1
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other El Denied Access
F2cilir,v Number Date of Visit: Time: IMCOM I I
ro _71t Operational Q Below Threshold
Mpermitted VCertified 0 Conditionsifly Certified [31kegisitered Dale Last Operated or Above Threshold -
Farm Name: - , I "I'L __ County: !�&&Y26nij
Owner -Name: A"11' Phone N a. 7/0-
Mailing Address: 3d76 -Ae-Ave. N( -2 9 3__1 f,, —
2D,
Facility Contact: yl llell" "4 —Title: Far-dn Ma. -I '71 ?,-
Phone No:
Onsite Rep resentative: Intear2tor: fir',W'�kw S?==
Certified Operator -
Location of Farm: Eall SI? 1?,0&
Operator Certifirstion Number:
51,5w-ine OPouttry OCaftle ElHorseLatitude & 9 " Longitude 0
Design Current
Swine ('a"neift, pn"13151tion
�ean to Feeder
0
El Feeder to Finish
El Fartow to lk"ean
El Farrow to Feeder
El Farrow to Finish
Q Gilts
El Boars
Design Current Design Current
Poultm Capacity Population atde capacity Povulatiou
JE3 Laver FEI Dairy--T I
E]
ID Non -Laver Ej Non-Dairy I I
10 Other T_
Total Design Capacity
Total SSLW
Number of Lagoons I 1LJ Subsurface Drains Present ULJ Lagoon Area JU Sprav Field Area
Holding Ponds / Solid Traps
L 03 No Liguid Waqe Management System
Dischar-es; & Stream imparts
I - Is anv discharee observed from any pan of the operation?
2rYes No
Dischame orieffialed at: 10 Lazoon El Spray Field 2-Kther
a, If discharue is obsened, was the conveyance man-made? Ej Yes 90-No
b. If discharge is obsm�ed, did it reach Water of the State? (If ves, notiN DWQ) -No
E3 Yes Q
c. If discharee is observe(L what is the estimated flow in gaUmin) Alk
d. Does discharg by [9-Yes El No
_e . pass a lagoon system" (if yes, noti6- DWQ)
2. Is there evidence of past discharLye from any part of the operation? [I Yes El No
3. Were then any adverse impacts or potential adverse impacts to the Waters of the State othcr than from a discharge? El yes U-No
Waste Collection & Treatment
4- Is storage capacity (fi=board plus storm storage) less than adequate? Spillway El Yes �o
Structure I Strucwe 2 Structure 3 Structure 4 Structure 5 structure 6
Identifier:
Freeboard (inches):
05103101 Continued

'j �
q
IFaciRty Number: g2 --?/(? Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes [__1 No
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 El Yes El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvcment? El Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 0 Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement? Yes No
11. Is there evidence of over application? El Excessive Ponding 0 PAN 0 Hydraulic Overload Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
El No
14. a) Does the facility lack adequate acreage for land application?
El Yes
El No
b) Does the facility need a wettable acre determination?
Yes
No
c) This facility is pended for a wettable acre determination?
Yes
No
15. Does the receiving crop need improvement?
El Yes
El No
16, Is there a lack of adequate waste application equipment?
[I Yes
El No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? El Yes 0 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) [:1 Yes 0 No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil. sample reports) [] Yes [] No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? [I Yes El No
21. Did the facility fail to have a actively certified operator in charge? 0 Yes El No
22 Fail to notifv revional DWO of emervencv situations as recluired bv General Permit?
(ie/ discharge, freeboard problems, over application) El Yes El No
23. Did Rcviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes [9<o
24, Does facility require a follow-up visit by same agency? G?Tes; 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes El No
[13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy D Final Notes
Wr'-slew6do,- "Js 06ser-ed C-­,,7,) dvvv�' Or a
"?-Cjeavlee- '770ved 4-0 Aach 07C Aovse- a761 AA-'7 /04,
lel4leel) _-2 40v_1,e5, el 7 ck.�,
'.Ou
try 15 -/Xrj/ Ulo5 OF,- IACP 9t00-7cl
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
05103101
Date:
Confinued

State of North Carolina ' 74 a
Department of Environment, MI.WA
Health and Natural Resources 00
Fayetteville Regional Office Alm
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary F11
Andrew McCall. Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
August 2, 1995
Mr. Carl Little
Dogwood Farm , Inc.
Post Office Box 49
Clinton, N.C. 28328
Subject: concentrated Animal Feeding
Operation Inspections
Dogwood Farms, Inc. Facilities
Sampson County
Dear Mr. Little:
Thank you for interrupting your busy schedule to assist in the
inspections of the Dogwood Farms, Inc. swine facilities in Sampson
County August 1, 1995.
Attached please find a copy of the inspection forms for the
facilities visited. We ask that you forward a copy of the forms to
the appropriate growers with the thanks of this office for allowing
timely access to their farms.
Again, thank you and Mr. Brian Spell for assisting in the
inspection process. If you have questions or comments concerning
the inspections please do not hesitate to contact me at (§10) 486-
1541.
sincerely,
Paul E. Rawls
Environmental Specialist
CC: DEN Facility Assessment Unit
Wacho,0a Building,SUte 714, Fayefteville. North Carofina28301-SW Telephone [phone] FAX[phone]
An Equal Opportunity Atfirmative Action Employer SM recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No. 2 -;� - ;L i e-Ir
DrVISION OF ENVERONMENTAL MANAGEMENT
AND4AL FEEDLA)T OPERATIONS S]TE VISITA71ON RECORD
DATE: August I -, 1995
Time: I I'. tC
'Farm Ni
-Mailing
County: samprznn
IntegratOT.f Dogwood Farms, Inc. Phone: [phone]--ext, 316
On Site Representative: r.,,:i Tittie. Do—nad Pa.— Phone�gin) -,97_2in4
Physical Addressa=tion:
Type of Operation. Swine _2L Poultry — Cattle
Design Capacity: Number of Animals on Site: 61. o t
DEM Cwtification Number: ACE___ DEM Cerfification Number: ACNEW_
Lztitude:_2�;7- Oa' _41" Longitude:_10 -
Circle Yes or No
Does ft Animal Waste lAgoon have sufficient freeboard of I Foot + 25 year 24 hour storm event 6eW
(approximately I Foot + 7 inches) (& or No reeboard:___.Ft. —Inches,(---
Was any seepage observed from the lagoon(s)? Yes" r_Vo Was; any erosion observed? Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No (Not Evaluated)
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelllngi? Q or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Sueam? Yes or k6—
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes Or No (Not
Is animal waste discharged into water of the state by man-made ditch, flushing system, or-dther Evaluatee
similar man-made devices? Yes or No If Yes, Plem Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied4Not Evaluated)
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: This wag a very Itreif inspecticm. q -1 lns,2er n I I 'hp
-mL rp rhnrn,,8b -tin wj
conducted in the future,
Inf Ormation noted on this inspection was obtained f rom the intergrator ol DEN f i I PA,
If you have questions regarding this report please contact Paul Rawls. DEM Water Qua3ity
Section at [phone].
Inspecwr Nam
1�7_ -- -
I t� L-n
Signature
cc: Facility Assessment Unit Use Attachmenu if Needed.