820273_INSPECTIONS_20171231

2 V
NUHTH CAULINA
Department of Environmental Qual

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: Gjr-7� Arrival Time: n r '/�� Departure Time: !DD County: SdI� Region: V-9t
Farm Name: +PVMOwner Email:
Owner Name: 0 PI+Q6e Phone:
Mailing Address:
Physical Address:
Facility Contact: ti Title: Phone:
Onsite Representative: l l Integrator:fes[[ge
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Design Eurren�t
Capacity Pop.
Wet Poultry
Layer
Non -Laver
D P,oul
Design
Capacity
Ca aei
Current
Pop:
Po . „
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEZCow
Non-Dai
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
HOther
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 IR No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

[Vacility l umber: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
F
❑ NE
Struc e 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ 3No
[] NA
❑ NE
waste management or closure plan?
77��
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
[j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDlicatioo
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ F
Heavy Metals (Cu, Zn, etc
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr p indow Ev' ence of Wind Dri ❑ Application Ou 'de of Approved Area
12. Crop T CXr �r
YP e(s): fQ
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EQ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
r
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
F No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall
inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

jUacilliq plumber: - 2'3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to
to
Reviewer/inspector Name: W 6'd-0 l
Reviewer/Inspector Signature:
Page 3 of 3
or, any
❑ Yes
L No
❑ NA
❑ NE
❑ Yes
C!�No
❑ NA
❑ NE
❑ Yes
�No
[] NA
❑ NE
❑ Yes [� No ❑ NA ❑ NE
[—]Yes
W No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑Yes
®No
DNA
❑NE
Phone: -VW
Date: - ZgLI-1
14.12015

f A._
type of Visit: Jp Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: LL
Farm Name_
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: /; Departure Time: 2.`� County: .574yy "Psp/j RegioW4
v l rn Owner Email:
RQ Y� _c Phone:
Onsite Representative:
Certified Operator: W ;
Title:
Phone:
Integrator: &SCj
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
* Design Current Design Eui-ren'
t
Design Current
Swine Capacity Pop. `'Vet Poultry Capacery Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Feeder to FinishDa
Non -La er
Da Calf
Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
D , P,o.ul Ca aci P,o _.
Layers
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
Urkey Poults
Other i
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 fT-t No ❑ NA ❑ NE
[—]Yes
❑ No
NA
❑ NE
[:]Yes
❑ No
NA
rj
❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility umber: Date of Inspection:'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No [!g NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes rO No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement? 1P
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approve 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
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
® No
❑ Yes No
❑ Yes No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 51 Date of Inspection: /4
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[PNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes PpNo ❑ NA ❑ NE
❑ Yes �? No ❑ NA ❑ NE
❑ Yes )91 No ❑ NA ❑ NE
[—]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments,(refer to.question #. • Explain aa.riYES. answers and/or any additional recommendations or an miter commehts:
" ' M�__ lli_..
Use drawingi':of facility to better explata situations (use additional pages as necessary) .:;
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ��d `�33 33t
Date: j v I AbAt"
21412015

(Type of Visit: ® Compliance Inspection U Operation Review U Structure Evaluation p Technical Assistance I
Reason for Visit: & Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Z: Departure Time: : QO County: SAWfDAI Region:
r^�
�
Farm Name: �� D Owner Email:
Owner Name: �Q U� Phone:
Mailing Address:
Physical Address:
Facility Contact; Da ki,,a Title: Phone:
Onsite Representative: Integrator:
Certified Operator: W r � 1 a rat rr ef- Certification Number: 7��/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
D'°`i n
,es g
Capacity
Current - Desi gn Current
Pop. Wet Poultry Capacity Pop. Cattle
Design
Capacity
•
Cnrrent
Pop.
Wean to Finish
Layer Da' Cow
Non -La er Da' Calf
= Da' Heifer
Design, -Current D Cow
D . Pouf =Gspa ci Po Non -Dairy
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Non -Layers
Pullets
Beef Brood Cow
reeirf
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
[]Yes
[] No
"r] NA
❑ NE
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
❑ Yes 99 No
❑ Yes j] No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

FaciliNumber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No to NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Ll
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Pq No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes §allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gyp} No ❑ NA ❑ NE
maintenance or improvement? h
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes P No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evi ce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C0461&��j Q 5...—
13. Soil Type(s): Be& j Wab _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fp No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination? F
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes 09 No
❑ Yes i No
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[PNo
❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
[DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facili Number: Date of insection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [:]Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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.
X Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[ ] No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [-]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWM[P? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _i IOV3- 3300
Date:L-Z/ S
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i u 1� Arrival Time: ] iW Departure Time: O/ :G1� County: Region:
Farm Name: \1 t 1 ( r- �23Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: U
Certified Operator: Yi f i1 i Q,Yh
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator: '&Are
Certification Number: /%2l
Certification Number:
Latitude: Longitude:
Design Current
Design Current
Design Current
Seine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
airy Cow
Wean to Feeder
airy Calf
Feeder to Finish
2ffM
2176.
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P,oult . Ca acity P,o
Non -Dairy
Farrow to Finish
Layers ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turk e s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 IF No ❑ NA ❑ NE
❑ Yes
❑ No
fW NA
Tj
❑ NE
❑ Yes
❑ No
NA
T
[] NE
❑ Yes
❑ No
® NA
T❑
❑ NE
❑ Yes
T No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: -2,7 Date of inspection: 11 2,v3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f�] No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes D No Vq NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EM No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�@ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvWencc of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): rC%-Vqo UZ.,
13. Soil Type(s): )
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
`7 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
QU No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
T
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes W,71
No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: t(203
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cp 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 lf� 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [P No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
E] Yes [� No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes � No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to- question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to .better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: < job arb le Phone:
Reviewer/Inspector Signature: �' �"l�t Date: 3
Page 3 of 3 21412011

type of Visit: W uomptiance inspection u operation xeview V btructure Evaluation V iecnnecai Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access _j
Date of Visit: Arrival Time: :©p Departure Time: , County: Region: CEO
Farm Name: ju l an��� Owner Email:
Owner Name: �pr j"+(eSCC,r Phone:
Mailing Address:
Physical Address:
Facility Contact: .5 LL D� Title: Phone:
Onsite Representative: 5 Limb b Integrator:? � _
Certified Operator: _ 1V� ',' Ga't je' Certification Number: G gZ2-f/%
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
C�aRacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Daig Calf
Feeder to Finish
DLt Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oul
Ca act
I:o .
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-'
Turkeys
Other
-:_ &
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

[Facility Number: $ jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes En No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1�3 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�j No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): jQ2L4cL_jPTR'U�[z(�-,r`Gt(�llE� --..
13. Soil Type(s): WL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [5 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 f�3 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2). Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFacirdy Number: ja- a Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
�g No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes )a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes J�j No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to,gaestion #): Explain any YES answersand/or any additional recommendations or any other comments:: a� P
Use drawings of facility to better explain situations (use additional pages as necessary).? �•
P-0 C , 'r I icy is- V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: // 131- 33CO
Date: j &
21412014

9VA 6W 30
Type of Visit: *Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: • 4D Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: p2:ap Departure Time: o Z ; ' ounty� Region: rdnQn
Farm Name:..
ame: ��3P0 �(.i` �Llyi �f tLh �(i ner Emait:
Owner Name: re Phone:
Mailing Address:
Physical Address:
Facility Contact: �( ��Ip`�- Title:
OnsiteRepresentative: 71,6
Certified Operator: w11 f 4M
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Qa h o
Certification Number: f0 �/� l It
Certification Number:
Longitude:
D�es�g Cure
0
Degn
Design Cnrrent
Swine
CapacitytP�op
Wet Poultry
Gapac�ty Pop
Gable Capacity Pop.
Wean to Finish
Layer
Daja Cow
Wean to Feeder
Non -La er
1
Dairy Calf
Feeder to Finish
Z. 'L
-.
Dairy Heifer
Farrow to Wean
Design Current.
Cow
Farrow to Feeder
Dr. P,oul
Ca achy Po ,
Non -Dairy
Farrow to Finish
ILayers
lBeef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
jPullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[]Yes �No ❑NA ❑NE
❑ Yes [:]No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ;P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes •M No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Ins ection: q IMy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�Z] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
Qj NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
5N' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?]
Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes '9_11 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �_<;4ar?Pxmc14� 6:;7t5S Qaj
, h O
13. Soil Type(s): 56 r Wa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes b No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP [—]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes (5g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

`
Facilit Number; - Date of Inspection - IM
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
©' No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
CXNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes �@ No ❑ NA ❑ NE
❑ Yes f�j No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes © No
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 9!�`�33 -y-&V
Date:
21412011

i ype of visit: qp Compttance inspection V uperatton xevtew U Ntructure Evamanon V i ecnntcat Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �(] / Arrival Time: Departure Time: h[� } County:SAO ps`,p�1
Farm Name: C'�23�lk�n r Owner Email:
Owner Name: R64 ' _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
11 �'*�Q4
Title:
Onsite Representative:
Certified Operator: ,11 jQrn CZ1lVY'Qk_e'
Bach -up Operator:
Location of Farm:
Phone:
Region:
Integrator: r S-6
Certification Number: 987-Q-91
Certification Number:
Latitude: Longitude:
Design Current Design ent
Swine Capacity Pop. Wet Poultry Gapactty p
Design Current
Cattle Capacity Pap.
Wean to Finish
Layer
Dair y Cow
Wean to Feeder
Non -La er
I
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
,�
VID-WO'Sn Current
D . Point . i" Po�.
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
I Beef Brood Cow
�., .
Dther
Other
Turkeys
Turkey Puults
Other
-
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
rCM NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[1� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
j
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ra No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
X No
iM No
}� No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
(� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F� No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RDNo
❑Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [R No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7❑' No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes `#@ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or'anyMber;conA eats.
Use drawines of facility to better explain situations (use idditio'nal'pa0s as necessary).
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
v: 5 t't on
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
❑ Yes W No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
[:)Yes M No ❑ NA ❑ NE
❑ Yes [Q No ❑ NA ❑ NE
Phone: 9ID`1'(33-33co
Date: y
21412011

Type of Visit 41 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: 'ta
DeFW
parture Time: 7f County: Region:
%
I m—a�Owner Email:
Physical Address:
Facility Contact: �r - Title:
Onsite Representative: Q es Cam 6 _
Certified Operator: ° lay`` u►-41W
Back-up Operator:
Location of Farm:
Phone:
Phone No:
integrator:
Operator Certification Number: 7 °Z'
Back-up Certification Number:
Latitude: 0 0 0 i =« Longitude: [:]° 0 3 0 u
Design Current DesignFun
Capacity Population Wet Poultry Capacipulation
❑ Layer
❑Non -Layer
Currenine
Cattle Capacity Population
❑ Wean to Finish
❑ DairyCow
❑ Wean to Feeder
Dairy Calf
eeder to Finish
o
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets.
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
i
❑ Turke s
Other ❑ Turke Poults
❑ Other ❑ Other
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
X3 NA
LP
❑ NE
❑ Yes
❑ No
NA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection l O +
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?
Struc l Structure 2 Structure 3 Structure 4
Identifier: e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r+
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes T No ❑ NA ❑ NE
[:1 Yes ❑ No A NA ❑ NE
Structure 5 Structure 6
❑ Yes �] No ❑ NA ❑ NE
❑ Yes P l No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 01 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes % No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Y9 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes b No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind
fDrift
s � ElApplication Outside of Area
12. Crop type(s) C(bs(� J,�WMJG\t"la"'1� , �f�+•t • u-ru=r r Ai
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[PNo
[:I NA
❑NE
PNo
[I NA
❑NE
[P No
❑ NA
❑ NE
[� No
❑ NA
❑ NE
® No
❑ NA
❑ NE
Comments (refer to question:#} Egplatn any YESanswers o 3 reco`mmendattons or any other comrrtentsu "I" i
Use draHm s of.facih to better es laEn s�tuahons use addittonaf a e c g ity p ( p ary} ,
..... tim vAv�s as necess fir}
Reviewer/Inspector NameM7
Phone:
Reviewer/Inspector Signature: Date: 10 I (0
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[PNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EP No
❑ NA
❑ NE
25. Did the facility fait to conduct a sludge survey as required by the permit`?
❑ Yes
fa No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JP No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
90No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA ❑ 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
JP No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[?No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�9 No
❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 5AI MMAJ Region: F"
Farm Name:
; 340)wner Email:
Owner Name: fiU L"r _J irt'S' fAt Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone No:
Onsite Representative: V0)"_G , L_arA6
Integrator:
Certified Operator: _
Operator Certification Number: r {
Bach -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O =' [=] Longitude: = e =' =
Design Currentjiiiii
Design Current Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
10 Layer ❑ Dairy Cow
ID Non -Layer ❑ Dairy Calf
❑ Wean to Feeder
Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Da Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Nan -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys ElBeef Brood Co
Other
❑ TurkeyPuults
❑ Other Number of Structures:
ElOther
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo El NA El NE
Discharge originated at: El Structure El Application Field ❑ Other (l
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No ` NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No N NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes `� No ElNA El NE
other than from a discharge? f
12128104 Continued

Facility Number: % Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Pallo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA ❑ NE
Sln lure I Stntcture 2 Structure 3 Stnicture 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Pb 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?
❑ Yes
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�10 El NA El NE
maintenance or improvement?
((
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/imp'rovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence ofWindDrift [:]Application Outside
of Area
,
12. Crop type(s) tom{ AaJ Pe-r YIJe ��aj'6�.1n Ow,,,/
13. Soiltype(s) VQi4y✓1 1l�ftzM
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5d m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
, ❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: ! V --3
ReviewerlInspector Signature: Date: d
12l28/04 Continued

Facility Number: —`� Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [:]Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
q No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
[INA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QQNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
t§No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ES No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
lj�No
❑ NA
❑ NE
Additional Comments and/or Drawwin s.. T.
• s;
.:: -
r -r
i
7
Page 3 of 3 12128104

Type of Visit *Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , Departure Time: County:
Farm Name: llm�nGi I`✓► i1"�'iZ��u�. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: rIMMi
l ,, �� Title: Phone No:
�
Onsite Representative: so- �'� "'� integrator -
Certified Operator: Operator Certification Number -
Back -up Operator:
Back-up Certification Number:
Region: )CAD.
Location of Farm: Latitude: = e = 4 = N Longitude: 0 0 = i = u
Swine
Design
Gag�act®tyPopulahon
FM
Current .:. Design CU.rrent- _;_
,WetP,eultry Capacity PoPulat�o�
Design Current
Cattle Cap�c�ty Population
_
❑ Wean to Finish.
❑ Layer
I
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
`=El
w
Daia Heifer
❑ Farrow to Wean
aaDry Poultry
y�
❑ D Cow
❑ Farrow to Feeder
.fir
❑ Layers
¢'
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- ❑ Turkeys
Otherir ❑ TurkeyPoults
c
❑ Other
JO ❑ Other
I
Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[�Vo
❑ 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
, 3 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)
El Yes
El No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12178104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ONA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 41911
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA [3NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
P No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
tm No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
f Wind Drift Application Area
❑ Outside of Acceptable Crop Window ❑` EEvZa,
'Outside
/❑`
12. Crop type(s) ' ` 4�-aW `�` `{ ' 1 �h� , c4rtu
/of
13. Soil type(s) �•Sf de�ty7ln
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes &No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
pNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/inspector Name Y Phone:( /Q? f3 S3�
Reviewer/Inspector Signature: Date: D8
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspectionil`r/01:51
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or
12128104

® Division of water Quanty
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Of Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0'7 Arrival Time: ;00 eparture//Time: 2 :M +►t County:
Farm Name: V`YVL n �1� -�b� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 4Title: Phone No:
-11
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Region:
Integrator• _.
Operator Certification Number:
Back-up Certification Number:
Latitude: Q o 0 6 0 Longitude: =°== u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design.0
Cattle Capacity PoF
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ml
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
El Yes
El No
RNA
❑ NE
❑ Yes
❑ No
1�NA
❑ NE
❑ Yes
❑ No
P) NA
❑ NE
❑ Yes
I. No
El NA
El NE
❑ Yes
L.N.N.
❑ NA
❑ NE
12128104
Continued

Facility Number. __'_117 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'No [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No WA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �r[
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[ No
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
['� No
❑ NA ❑ NE
through a waste management or closure plan?
i
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
L❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
fm
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) +4 y l Ln r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
P0 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
an A
T
Reviewer/Inspector Nam �f ST�AI>: y one: ��
Reviewer/Inspector Signature: ate:
12128104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [� No ❑ NA El NE
the appropirate box. ❑ WLTP ❑ Checklists El Design El Maps El Other 1
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes TNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
IQ
ElNA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
_P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
99 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
12128104

Type of Visit Qr6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q4out1ne O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a- o d - Departure Time: County: Region:
Farm Name:int�il lC� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representativ
Certified Operator: Operator Certification Number:
Back-up Operator:
Phone No:
Integrator:
Back-up Certification Number:
Location of Farm: Latitude: [� o = [� 64 Longitude: = o 0 t =
11
TA
rrent
owpolu
Design Current
Design Current
Swine lation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
ff'Feeder to Finish
fl
Dry Poultry
❑ La ers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy_
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
fp No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
fo 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
p NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 2 731
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ? No ❑ NA LINE
a. If yes, is waste level into the structural freeboard? ❑ Yes [-]No ]RNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
i
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
N No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[B No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
g] No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CoNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
1�No [I NA ❑NE
IN No ❑ NA ❑ NE
;Comments: (re&r to question Explain any YES answers and/or any recommendation or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):-
Reviewer/Inspector Name Phone: �� � 3�g
Reviewer/Inspector Signature: Date: —
Page 2 of 3 11 - 1" 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes §4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MiNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No []NA [:]NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
( No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L 5 No
❑ NA
❑ NE
Additional Comments and/or Drawings: _1
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: u? = /$' Departure Time: County: SCw.10.9AA1 Region:
Farm Name: CLrw� Owner Email:
Owner Name: [per + �re�-fd�� Phone: (9 10)
Mailing Address: 2 G? j .21 b a�'•y
Physical Address:
Facility Contact:
Title:
Onsite Representative: ay..QQW ar �ra�-fr
Certified Operator: a onAu
Back-up Operator:
Phone No:
Integrator: (01.
Operator Certification Number: 779L
Back-up Certification Number:
Location of Farm: Latitude: E--] o =1 ' = Longitude: = ° 01 ❑ it
7
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 0'4 kb 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars L
.Other
❑ Other
❑ Layer
E
❑ Non -La et
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Capacity Population. .
❑
DairyCow
f
El
Dairy Calf
El
Dairy Heifer
El
Dry Cow
ElNon-Dai
El
Beef Stocker
El
Beef Feeder
❑
Beef Brood Cowl
El!
Number of Structures: _ -J
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system`? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [50 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of inspection 50i •�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[O No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[Z No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
T No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[A No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) c ,, ,,, .� �o� �+r a , 5 G OS
13. Soil type(s) p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(fi No
❑ NA
❑ NE
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: 4/ ,7
12,1&04 Continued
i

Facility Number: Date of Inspection 't .2770_71
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes © No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fait to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
m NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
M No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
AdditionslfComm.ents /an/roo Dii*iu gs I_
P S v Gin (h-s P e 1vt G n+ .
L�tss f r bra�i'a�v ezr 30— S /Kjg-- . rt< rvex' C_
12128104

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit • Routine O Complaint O Follow up Q Emergency Notification O Other p Denied Access
Facility Number Date of Visit: a Time: d .J
rONotOperational O Below Threshold
[yWermitted .Ifferdfied Q Conditionally Certified 13Registered Date Last Operated or Above Threshold:
n
Farm Name: ..... M-ia.4ra1........!.�.. a_ 66-a r_4--------FGfr,_ --- - County: r�t±,;P.SQtr-------- _.. .�/t':�.....
Owner Name: -.... fQa � r..1L..... P..�cs a ...... .. Phone No: .... ....- 33.........................
Mailing-Address:.._2.c2..2k_._...5..e....... I w�r... l.Q ..F .. HGxr �� ....... l-V! L ._. .... ��. y` .. .... W........
Facility Contact: ..LLB[ f eP[�f�G�Q !��!Lc�Title: --.-.- —�_ _.... _. Phone No:
Onsite Representative:._.. �,c%�.�� . �..__ . Integrator-. /,0"1-ill, _ _ __ .
Certified Operator: ... ..... / ���.t ...... ,,_----- _�.... Operator Certification Number• /�3 Ds -
Location of Farm:
�ine [3 poultry [3 Cattle ❑ Horse Latitude �• �' �" Longitude
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes &M
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? [:]Yes jxo'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Q46,
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 ❑ Fdo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q. No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�fiTo'
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes DX6
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... -.j .......................................... ...... .... - ................. ----................ .............................. .......... .......................
Feehoard (inches): ,? 7
12112103 Continued

• Facility Number: — .:�? Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
EHO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
�o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
EKo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
O N"o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
i 3'no
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehimprovement?
❑ Yes
BNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
pro
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 13eW/„ SM,. II G.� , .� - All
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9wo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
®-No
b) Does the facility need a wettable acre determination?
❑ Yes
BNo
c) This facility is pended for a wettable acre determination?
❑ Yes
8-No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Q-Ko
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
0-No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
�o
Air Quality representative immediately.
❑ Final Notes
i7 {Pw wed
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/
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Croy {'os{ ehou94, Tti,'s �";�f a�foev fhE coasrli� �tl P.Stadi�'Sf a 9.a�
5 /a., J r^dsle.
Reviewer/Inspector Name ' '`�
.�
Reviewerllnspector Signature:
Date:
2 L/ l L/VJ 4VlHN*9&V

Facility Number: — ? Date of Inspection S v
Required_ Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have al compnents of the Certified Animal Waste Management Plan readily available?
(ie), heckli , desipe, moKettc.)
23. Does record keepin need improvement? If yes, check the appropriate box below.
❑ Waste cation ❑ Frg;b6ard ❑ Wastg ysis ❑ Soil San!ioifff
::74 5 :�. L 1.,?-a3 -)-?. p q-14 -) 1. 2 7-.2.7 71, & 41 - 7 —�a o
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑.M
❑ Yes Q'N-6-
❑ Yes aWo
❑ Yes 0Wo
❑ Yes 0KO'
❑ Yes O-KO
❑ Yes ❑o'
❑ Yes &Wo
❑ Yes !moo
❑ Yes 2io
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Site Requires Immediate Attention: I40
Facility No. S Z - 2 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7u t `� 1995
Time: 1 -.3 3
Farm Name/Owner: LLeeJ Lee_ Qu-t- e-r
Mailing Address: 414 . B uil -e- j— H v e.__. C W4o tj Ail.—_ . 2 S 3 Z $
County: Sampsa,v
Integrator: �a s z Phone:_ (9/D) 59Z - 5771
On Site Representative: Le_e_ 83 Ve Phone:l�[O_) 59Z 759'&
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: 2_4tS0 Asti Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficien
(approximately I Foot + 7 inches) Yor No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? Yes or No B
Crop(s) being utilized: crna.A_Ja_ R e
es
t
freeboard of 1 Foot + 25 year 24 hour storm event
Actual Freeboard: z Ft. ! a Inches
Yes o No Was any erosion observed? Yes or(&
Is the cover crop adequate? es or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellig_e_s
es r No
100 Feet from Wells? r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N&
Is animal waste discharged into water e state by man-made ditch, flushing system, or other
similar man-made devices? Yes on If Yes, Please Explain.
Does the facility maintain adequate waste management rec r s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: —rX,'s 19?V- . Rec,,s/zrzcl Ski
R;C_ Rc.\Je (5
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
3

i
3 ' _3'3
1WRTB CAROLMM DEpARTMMU OF , MMLTN L PUMMAL RZSOU X=
DIVISION OF MMMOMEMTAL
Fayetteville Regional Office
Animal Operation Compliance inspection Form
f .. i�ARK iJOWl�3 �I3d5FECTiON
ATE
x ilia "- M
_`ra :
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Cee &t1 e 8utl er
y.'�.y6�-.-,.���-lT-T�•:��Nr� _ JY:" '
M11-TMG..�L+i.�Li.�M7a7
e-.�;� �/��� �000-ve��: ��0'.4 .w^.;�trba�< �� p«f. �.tia.�� •n.
fly BWer Dr. Gtn6n ze) 329
010) 5g2 8590
All questions answered negatively Will be discussed in sufficient detail in
the,Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SZ=ION I
Animal Dteration _ Type: -Rn, sh
Horses, cattle, wirte poultry, or sheep
SFCTIOM II
©© • 17
7. noes the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with licluid Waste
system)3
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIM
WASTE KANAG 29M PLAW.
5. Does this facility maintain Waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
Wells, etc?

s�rlo� =zI
f+3e1 Site �tan�ent
1, to animal va&Lw sLuakpilad Or lagoon
construction within 100 ft. of a USCS
Nap Blue Line Stream?
2. Is animal waste land applied or spray
irrigate] witr4n 25 ft. of a UraGO Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application -sits have a
cover crop in accordance with the
CERTIFICATi PLAN?
5_ Is animal waste diacharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal Waste management at this
farm adhere to Best Management Practices
MY) ) of the approved ,CJM=C2l1'i�N'i
7. Does animal waste lagoon have sufficient .S
freeboard? Now much? (Approximately Z)
6. Is the general condition of this CAFO facility,
including Management and operation,
satisfactory?
swrim ry
Comments

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UGISTRAT_nN C.M. FOR ANIMAL r _ED_LO7 C'PE-RAT TONS
Department of Environment, aealt?'I and Natural Resources
Division of Envircnmental Management
Water Quality Sec ion
rR the animal waste management system
for your `eedlat operation
is
designed to serve more than or
equal. to 100 head
of cattle,
75
horses, 250 swine, 1,000 sheep, or 30,000 birds that
are served
by
a 1.cuid waste system, t en
form must ce filled
cut and mailed
by December 31, 1 993 pursuant _..
_5A NCAC 2 .02_7 (c)
in artier to
be
deemed pe- nizzed by DE.M. ?? ease
print c'_early. .
: a-m Name: ( ge l� 14-r _.
Mailing Address 4-Ly _6ir c4IQ.ki�r���n
Ci�n-t7'r� NC Z-,
CounT:", :
Owner (s) Name: I-ee- 1_S .7r•
manager (s) Name:
Lessee Name:
Phone No.
Fay Location (-eras as possible: road names, direc-ion,
milepost, etc.) die+h iruKc- ,r e-n tq 4r,-4--P
r'IA;l -. ( 16,Ji r Ir-V�V1 rAi 4-C',rc+ -f—nvrA -r 47 ar v-\ r s r. hT
Latitude/Longitude if )mown. r-�P __:3-L7a1 - 1a� - y - G
Desicn capacity of animal waste management system (Number and type
cf confined anima_ (s)) :UAL? F .f.enPr -)r-
Average animal population on the farm (Number and type of animal (s)
raised) '
Year Production Began:_IC
L89 ASCS Tract No.:_��,
Type of Waste Management System Used: L n a
v .j
Acres Available for Land Application of Waste:
Owner (s) S ignat::re (s): 18 4,-al DATvE
OATS: