820361_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
X);

Date of Visit: O Z JBArrival Time: u f . �J Departure Time: Z : I County: SA,e
Farm Name: _-ReAllj%/c ro? /utf f Owner Email:
G
Owner Name: �(%!r!/y/L AW-J A� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: �-7 Title: S601�7-G Phone:
Onsite Representative: 6 integrator: S�itIT JL�u�
Certified Operator: LG1 Gq'S ��zr� Certification Number:[y Z 5
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Carre©t s
Capacity Pop I : VIWet Poultry
Layer
Non -La er
Design Current
`Capacity ' Pope
f
, , I
Design. Current
Cattle� ,' Capacity Pop.
DairyCow
DairyCalf
e
Feeder to Finish
p
-
-
DrP,on1
Design
Ca aci
i
Curret'
Po I
DairyHeifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Either,
Other
Non -La ers
Pullets
Turkeys
Turkey Pouits
Other
Beef Feeder
Beef Brood Cow
I �..
iarl
� "h �;�i
h
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?
❑ Yes ffNo ❑ NA ❑ NE
❑ 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
No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
E
❑ 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
21412015 Continued

d
Facility Number: -30 N� 1 � Date of Inspection:
Waste Collection & Treatment �
s{ 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):-1^h
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 environments threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑-1es 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 EfNo ❑ 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 OZNo ❑ 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)= Sl%�C�✓,l.I S✓DEY�t%� �CLE1Glil E �/ ;�vt 1 ' _ FJ✓i 21C`C
13. Soil TYpe(s): 04 L ,tip T7 C� h/
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
[' "v
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ETNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
10
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rye uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FacilityNumber: - Pv Date of _Inspection: t9V
20 10
* 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(cs) 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 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
Fa<o ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[-]Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Noo NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�<EINA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0--No ❑ NA ❑ NE
Comments (refer to question # Expla�nn any. YES answers and/or any additional recommendations or any other:11.1 comments e� I g
Use draw' facih rngs'of 'ty to betterexplam s�tuattotts (ase additionak'pa�es as°necessary}. ;' i'`�
_)� iK_1X' '5� 4:5, AA0,7S
s�.uvc�� S ✓L�`% g�,��� I g o = 3. (V 3. 3 7 1,4— X';z — co;K)
WA-1 r s/}u-� Pam,✓ 8�,t /2oi iV = I -
141//z R Z 0 - i N G vm P14+ v1 "
I
�cC�2 � S "✓j Eyt�� 13 Ps C zoi B
Reviewer/Inspector Name:
l�� `wH I rLf
c--- 1 _ " 1 -r --
Reviewer/Inspector Signature:
Page 3of3
Phone: 'I;�. 7 3 3 . l D✓
Date: r-C 2-dl
21412015

361
Type of Visit: O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: VZ—A&—lA Arrival Time: / ; o Departure Time: / .'3D lCounty: S Region:
Farm Name: Dn h t z- �/�z-.�a�.'r!'�- Owner Email:
Owner Name: Z12 E2 1�� tom- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: _ Phone:
Onsite Representative: Integrator: 117?
a
Certified Operator: Certification Number: �fr
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
smow
Design
Swine Capacity
Wean to Finish
Current Design tlurrent Design .Garrent
p.
Pap. Wet Poaltry Capacity Pop. Cattle Capacity Pa14
La er DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
BCC
a
©. P.onit .
Dai Heifer
Design Garrent D Cow
Ca acit� 1?0 Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
Gilts
Nan -La ers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation?
❑Yes
C9.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2_ Is there evidence of past discharge from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
MNo
�] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2142015 Continued

'IFacility Number. - -3 h [ Date of inspection:
b -
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Uj4No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[] NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rZp
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
n Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E[No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 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
Lg[No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s).
13. Soil Type(s): h—-�
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
RKJNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
&�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
K'] No
0 NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ONE
Page 2 of 3 21412015 Continued

' Facility Number: - C, Date of Inspection:
( 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �d 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:
25. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes 7[No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J� 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?
ion'#) Explain any YES'aaswers and/or'any' add
Reviewer/Inspector Name:
Mary)
❑ Yes KNo ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
0 Yes KNo ❑ NA ❑ NE
❑ Yes
E;� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

1�
WIN
ivision of Water Resources
Facility Number 5�2_ - ,3G O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompy nee Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: eFRoutine O Complaint O Fallow -up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 4-/ Arrival Time: ,f� Departure Time: County:Region: ,
Farm Name: /�!7 n 2- [�l�i�� / a r'A-1— Owner Email: "�—
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: e ff-)1/2'r p r z- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
c , Phone:
Integrator:
Certification Number: k %/r?5--
Certification Number:
Longitude:
Design Current �` Design,Current"�" Design Current
Swine
X -
Ca acttyPo WetPoultry Ca Cattle Capty Pp.
• p p y c h Pop acio
T
Wean to Finish
Wean to Feeder
eder to Finish
Farrow to Wean
Farrow to Feeder
=_ La er Dai Cow
Non -Layer Dai Calf
UU 9-V p = Dai Heifer
Design `Current '4 Dry Cow
_==Dr P,o_ultry + Ca act 'yt,V=PoINon-Dairy
Farrow to Finish=
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
11, Beef Brood Cow
«.
Turkeys
Other
, _ . t 9
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any pan 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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
-
❑ Yes
®.No
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:_ _6
Waste Collection & Treatment
►* 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): J `�
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
C�],No [] NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ff!�No [] NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 54-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 Ef-No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �jNo
❑ 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 (2LNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [6-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below-. ❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C�-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r;-A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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
E.No
❑ NA
❑ NE
Page 2 of 3 214120I5 Continued

Facill Number: - 5� j I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo
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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/]nspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes L&No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes 2.No ❑ NA ❑ NE
❑ Yes [FI-No
❑ Yes No
❑ Yes r;_a,—Nlo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: /.;;, L -- /Z_
21412015

lv
Type of Visit: %Ormll'nce Inspection O Operation Review 0 Structure Evaluation 0Technical Assistance
Reason for Visitne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LI_fC! `,i—r,� i Arrival Time: pC7 Departure Time: ' County
Farm Name: �on�; ��-�/`r �af h-• Owner Email:
Owner Name: 1-7!J/1 rl f C-13f1-- � Phone:
Mailing Address:
Physical Address:
Facility Contact: & rx-,mil` LI' Z:.-- Title:
Onsite Representative:
Certified Operator: Luf_m �-
5� .._. Phone:
Region: �-
Integrator: /W4Q/ ff
Certification Number: q'q(p %2 jJ
Back-up Operator:',, Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
va
on -Layer
Dai Calf
-
Design Current
D . Pout o Ca aci P,o
La ers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turke s
Tur ey Poults
Other
­ �
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (galIons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge frotkany 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 [3-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [—]No
[:)Yes No
(�
❑ Yes U. No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

FaciliNumber: - Date of Inspection: O --
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo
❑ 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
E] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
f]-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 Amilication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RL 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): ��NXSi c t� �-- %� Y
13. Soil Type(s):
aY✓
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
[a No
[] NA
❑ NE
ayes
2jNo
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [8-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: C<Vz - , b Date of Inspection: p-
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 [a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [5j No
❑ Yes [RNo
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Ne,dj
mments (refer to.question #� Explidn anyYEan _ S swers andlor any a dditionatrecommendations or any other. comments.'
awings-Ulacility_ to,beiffiT a plan srtuatioins (use additi"alwees as;necessarv)..,E':.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

0-
f'i
z Wjjvision of Water Resources
Facility NuEnber LJ - ro Division of Soil and Water Conservation
QQ Other Ageecy
Type of Visit: ,,..,,omppliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O cK utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L
Arrival Time: /,'pZ7
Departure Time:
County:. s Region:
Farm Name:
Chin i r-r—,:rdo�—
Owner Email:
Owner Name:
XD,7p7 r G enev ff�_r-
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: '� Integrator:
Certified Operator: Le67'" /715,y/` Certification Number: 'n'i�f��j _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design .Current
Design Current
Design Current
Swine Capacity Pop.
W
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
DairyCalf
Wean to Feeder
Non -La er
eeder to Finish
(',"
DairyHeifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
Non -Dairy
D . P,oul Ca aci P,o ,
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
TurkeyPoints
Beef Brood Cow
Other F =
Other
I I
10ther
Discharges and Stream Imnacts
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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
YM No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZI No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - (d Date of inspection:
Waste Collection & Treatment
t. 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ 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 Callo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RNo
[] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M-71 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [] Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s):
13. Soil Type(s):
M. 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?
❑ Yes
M No
LJ NA
❑ Yes
I.No
❑ NA
❑ Yes
rV? No
❑ NA
❑ Yes
Ja No
❑ NA
[—]Yes RNo ❑ NA
❑ Yes [KNo
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ZI No
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I. 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 Sl No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes M-No
❑ NA
❑ NA
LJ NE
❑ NE
❑NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: Z D—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No ❑ NA [] NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ANo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
DS.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
IK No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[&No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
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
O No
❑ NA
❑ NE
Coivmeats (refer to question #): Explain any YES.answers and/or;any additional recammendataons oriany,�otber coninients:
Use drawin s of•,facilito;better explain:.situa#ions (use additional pages as.netessary)': rf�.4
A_eZrz/ Ae- v-f-PlUf ry
Reviewer/Inspector Name: _ V—e CC_ C-r- -�--
Reviewer/Inspector Signature:
Page 3 of 3
Phone: !/lYy.7�-13:)7C0
Date: / 0 3
21412014

iv"ision of Water Quality ��- /D
Facility Number ®- ;�L f O Division of Soil and WC ater onservation
Other Agepcy
Type of Visit:
rCom fiance Inspection n
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit:
ZRoutine 0 Complaint
0 Foilow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: 1j2 Arrival Time: y Departure Time: ;' County:
Farm Name_ iZn K ���'tr/ ��/�7v Owner Email:
Owner Name: N n ; �r' I ''1� Phone:
Mailing Address:
Physical Address:
Facility Contact: �� rsr�`"� Title:
Onsite Representative: Certified Operator: �`t3rtv!%r- `r
Back-up Operator:
,� Location of Farm:
Latitude:
Region:
k�." Phone:
Integrator: /�4,A
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to, Finish
Layer
Non -Layer
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to' --Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry Poultr
Ca acit
1'0 ,
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other I
LJ20ther
Discharees 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 KNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
E!�No
❑ NA C] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - 3b Date of Inspection:
_J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cg-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 3 ly
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2gNo
❑ 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): l.�di�*--- C�Id zr
13. Soil Type(s): 4 Y-&aavers-.1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
$ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
r
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[R-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RLNo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facill Number: - Lj 1, jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,a 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 the 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
allo
❑ NA
❑ NE
❑ Yes
rM No
❑ NA
❑ NE
❑ Yes
[21 No
❑ NA
❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes R No
❑ Yes . Cg-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question„#): Explain any YES answers and/or any additional recommendations or=any other coiifinents
Use drawings of facility to better explain situations {use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 2/p
Date:
21412011
Page 3 of 3

1 4
ivis`ion of Water Quality ��'{`� / +-►—l3
Facility Number g' - 3 l• �eeO�
vision of Soil and Water Conservation
herAgency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
-/,T- / rrival Time: , t_ D
Departure Time: ; DO
County:
Region:
Farm Name:
9 Dn n r C_ f 2 e`t /- Fa ,-z
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I
Certified Operator: x0 r►r ;1r_�-
Back-up Operator:
f r� Moore_ Title: '— c
Integrator: /WIZ
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
n
Design Current`s � k �^� � ::. ..Design Current�,�°�,�£•
Wet Poult . Ca aci I'o
Swine Capacity Pope ry ty P
, '_ Design
Cattle Ca aci
- p ty
Current
Po P•
..
Wean to Finish
Wean to Feeder
Feeder to Finish
Q
CID
La er
Non La er
DairyCow
DairyCalf
'� ,r R --
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to FeedersPouIt
Design Current
i
. Ca aci P,o
Farrow to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
ether
;, :;°
Turkey Poults
Other
Other
Discharges and Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 Lallo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Dste of Inspection:
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
❑ NA
❑ NE
Structure f 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 [R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes [3 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): Znrmu nvr f S r"-Z / , _s'Dr"sh U )n I .%r Gr-' 3S
I �32ez1 r-�
_
'
13. Soil Type(s): J Ors t a Grn l f: I L '7%] n HQ r-k-
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 J�jNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ® No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 3(, Date of Inspection: -- I —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®, No
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ®, No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [ANo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes © No
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [KNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments refer to question #t) Eaplain.any YES answers and/or any additional recommendations or any other commentM-1­­
drawingsf q I
of facility to tietter;explamisituations (use additional pales as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /n- L --33c %
Date: /.:2--J 3
21412011

A
Onsite Representative:
Certified Operator: _ ��, h; le
Back-up Operator:
Phone:
Date of Visit:Arrival Time: /'r;"3 D Departure Time: '.00 County: Region:
Farm Name: Ko olk7 i r Ca r tr-r- Farr'" Owner Email: �`—
Owner Name: `?1 p n ✓i i L F C., Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 7<Ze- .
Integrator: f'MAvd
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Current
Des gnCurrent
Design Current
Swine �--� Capacity Pop.
Wet Poultry Capacrtv° Pup.
Cattle__ : Capacity Pop.
Finish
Feeder
Layer
Non -La er
Dai Cow
Dai Calf
Finish
a', :_
Dai Heifer
o Wean
"
Design Current
�_
D Cow
o Feeder
;Boars
D , P,oul ,
..
Ca act P.o
Non -Dairy
o Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Pullets
Turke s
Beef Brood Cow
r
Turkey Pouets
ELAOther
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 [Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes 0 No
❑ NA (] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 3 (p ( Date of Inspection
'. Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CZ�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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
(a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
1Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s) �r'.-h�s a /l�r�Y�r l r'.SC �c c_• —
13. Soil Type(s): ` L
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 [3 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?
Required Records & Documents
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 24 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E[ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Z No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
ELNo
❑ 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 ® 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 E@ 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?
❑ Yes ® No ❑ NA ❑ N E
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
[:]Yes [ No
[:]Yes No
❑ Yes g!jNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: fr�',�..f_ . �� Phone: D" 33a0
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

ivision pf Water Quality h6 tr
Faeiiity Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit &4 ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 3 Departure Time: = D l7 County: Region: ��
Farm Name: On N i e! fn� ✓��/ af � _ Owner Email:
Owner Name: Dr? rr e Phone:
Mailing Address:
Physical Address:
Facility Contact: &4s-JLe (farld�r Title: Phone No:
Onsite Representative: Z�-l- / Integrator:
Certified Operator: Qh H % tea —T�� Operator Certification Number: g 7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F_1 a [—] ' = Longitude: = ° = t = 6i
III
Swine
r-egn Current^
Capac ty P6 Ulation
esign � Current
Wet PoaltryJF�
Cap�ac ity Pip i won
Design Current
Cattle Capacity Popniation
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
- _ __
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
ElBeef Feeder
EEl0103Boars
❑ Pullets
Brood Co
Other'
w y _
❑❑Beef
Turkeys
❑ Turkey Pouets
rr-
Fl:—]Ot'her
.. ..: _
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[9,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:g 3� ( Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ 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): / q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 J4 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
Z No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[R No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
g[No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ of Wind Drift ElApplication Outside of
Area
IEvidence
12. Crop type(s) / S A
13. Soil type(s) j A,,,„ �, ,��•.k G f�y-uY�"'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;9No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[-Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L. No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0,No
❑ NA ❑ NE
4t
Comments (refer to -question #): Explain any YES,Kanswersiand/ar any recommendations�iir any other Comm
Use drawnngs oftacility to better explain situa#rons (use:addthonal pages as necessary} y'
An .v�r�71c� rs F s o
NfJ1 f'r New H? d ✓>Z �- /L � a 5 err, t i ^ b�e�e% 5�.` /%w�. K b1 C'oc• s-✓.-a� C Fitt �� 7 -�,
Reviewer/Inspector Name '#" , r Phone: D
9`iD �/ 33�-.Z � O
Reviewer/Inspector Signature: Date: /�—/ Y-�/ c7
Page 2 of 3 12128104 Continued

Facility Number: 3 &(1 Date of Inspection
ti
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5�-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropriate box. ❑ 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 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
EgNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6jNo
❑ 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
UNo
❑ 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
IgNo
❑ 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
[SNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
! £J t' J` �'.-.�! j� ✓ J r i'1r�C�-rr� ! '�� ' + `ale`i c
�/. NOD (/��
17011,-L- 01'C —jS bra rho 4---
Page 3 of 3 12128104

,8,1-mS /2-/S- 2009
Type of Visit 07Compliance 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: �Z -fir O `j Arrival Time: Departure Time: County: 96=4 ftP6, Region:
Farm Name: I�aNNi crGt/ C Owner Email:
Owner Name: lCaNrfI`L CaV-%. � Phone:
Mailing Address:
Physical Address:
Facility Contact: Gy-,e_y- A oo-rTitle: T� Phone No:
Onsite Representative: r .c-c—�d ►ram „_- Integrator: M " 13J-O-S-^J
Certified Operator: ROM -Le- - av-L-Y Operator Certification Number: /90 71
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = i = Longitude: = e = 1 = "
Design Currefat
Design Current
Design Current
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
n to Finish
❑ Laver
❑ DairyCow
n to Feeder
❑ Non -Layer
❑ DairyCalf
er to Finish Zoo
1 `l Z
❑ DairyHeifer
w to Wean
Dry Poultry
❑ D Cow
w to Feeder
❑ Non -Dairy
w to FinishEl
LEBoars
❑ Layers
Beef Stocker
❑Nan -La Non -Layers
El Beef Feeder
s
❑ Pullets
❑ Beef Brood Co
MEMO-
❑ Turke s
❑ Turkey Pou Its
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
El No
,�,/
LT NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
B-'9A
❑ 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
❑l No
EJ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L--ff No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B o-
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:52--Ut IDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u-c !
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): % 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3"No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �,�
6. Are there structures on -site which are not properly addressed and/or managed El Yes L TNo ❑ 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 L�'fN/o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L? No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �,
9. Does any par[ of the waste management system other than the waste structures require ❑ yes [ o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes L7 No [] NA ❑ NE
maintenance/improvement? ,�,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Eld
Yes I_'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Fr07en Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri#i ❑ Application Outside of Area
12. Crop type(s) 61e-r-+w,/c4 �ff4c./�✓o3 �eSGu �C_ t!67r.., . C/o •53
13. Soil type(s) 14.' .n/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Tff oo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
ET'N'oo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
El Yes
L,i N/o
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L'J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D<o
❑ NA
❑ NE
tl `y P O R wr4 s sv 6...,ik d !o�- i+,i y L-7r.. ' 1-k a l SP ° kc, ;ram- �•J:.�« .-
6y ra....tr:t� �+ s;4- Af-8 / / /7
dr�Y. Y�fe4ft..l iS.f �14 a!/c,.�f Gr.wc.ri.eV4L SA;l/ /`S NaT ✓._t.d f+r KA0 54 I
.141. ✓ roes
IJo4c' F, fr rec/,'siJ 3%d l=r.��--w t.-Jprop--'G wt4il.;'�7nrcd /aj0zU1/ /e ile
Reviewer/Ins ector Name � � x 'u�, -, l r °` ' `' Wo, _U,13 0 a
p _ c✓ s :: y A x, Phone: �/
Reviewer/Inspector Signature: R.e�� Date:
12128104 Continued

._-
Facility Number: 82 -3Date of Inspection iz-IS-D 9
Reouired Records & Ducuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Etl4io ❑ NA ❑ NE
the appropiate box.
❑ WIJP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [iqo- ❑ 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 [ l4o ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E+i90 ❑ 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
2-No-
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-w
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[--]Yes
[ iz- ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B5q-o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 11 o
❑ 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
B'I o
❑ 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
DIM-
❑ NA
❑ NE
General Permit? (ict discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E!�<
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑" 1qo-'
❑ NA
❑ NE
Additional Comments and/or Drawings:
l2128/W

- - ivision of Vi'ater Quality
Facility Number $Z(D / O Division of Soil and Water Conservation
Other Agency
Type of Visit 9'�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: jZ -/S-b8 Arrival Time: �r� r� Departure Time: j2; / f County:
Farm Name: o u N CaAt Owner Email:
Owner Name: R° o m t c- CQt4W Phone:
Mailing Address:
Physical Address:
Facility Contact: G re c (I`il°ar� Title: 1¢.c `cam Phone No:
Onsite Representative: t"+�- M°°Ys-- Integrator: Ma�P �rd►.I�J
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region: ?9?K
Location of Farm: Latitude: = 0 0 ' = Longitude: = ° =
Design Curren# Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
® Feeder to Finish
4 ��
Dry Poultry
❑ l a ers
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Pullets
❑Beef Feeder
❑ Beef Brood Cowl
❑ Boars
«—
Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No LI NA ❑ NE
❑ Yes
❑ No
IJ NA
❑ NE
L7 NA
❑ NE
❑ Yes
El No
❑ Yes
N1
El NA
El NE
❑ Yes
�L"'J�
I� No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of inspection F/z-I3'-d t5
Waste Collection & Treatment DI
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D Noo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L7 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J&Okmf4 f /
Spillway?: ye S
Designed Freeboard (in): /9
Observed Freeboard (in): Z ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L7 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El" Yes N/o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes l-7 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 [I Yes LlNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance/improvement? �/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind} Drifl ❑ Application Outside of Area
12. Crop type(s) SoY4lt,�„� tr6- t S J E.",w.4,iA-p Cr';' e0s,
13. Soil type(s) o w+w.A i�.a,.,t IL Lew %6y c j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LT No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
['Flo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[ErNNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
lrr_--T&�o
El NA
El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E3 o
❑ 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 ;c ReJ�C_i.x Phone: 3330
Reviewer/Inspector Signature: -h— Date: 12 /S- ZOO 16
12128104 Continued

Facility Number: $Z — 3loi Date of Inspection
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [R<o ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 91� o ❑ 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 [Tlo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Dlo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Do
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El2 Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LSNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B,_.,<�o
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
L7No
❑ 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
,--,�
Lslvo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�/
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�J-1Go
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ETNo
❑ NA
❑ NE
AdditionalTComtnenis and/or Draw ggkm,, ;"
Page 3 of 3 12128104

Grl6ivision of Water Quality .
Facility Number _ 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
016utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: f2-I3 "07 Arrival Time: Departure Time: County:Region: cjeo
Farm Name: D NN i CcL%4e_r # 1 Owner Email:
Owner Name:_ 1R6#J"i_� C&tj"r- Phone:
Mailing Address:
Physical Address:
Facility Contact: �O ^r< <- Gow Title: OWN e.4,— Phone No: 910, 490 . ?AZ/
Onsite Representative: Z?_01JN i 1C__ Car-Aic-
Certified Operator: l omr4 o- GL4&.
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number: IT07 1
Back-up Certification Number:
Latitude: 0 c = i = i, Longitude: = ° = i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish Z 000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ 70ther
❑ La er
❑ Non -Layer FEE]
Dry Poultry
❑ La ers
❑ 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?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
® No
❑ NA
[I NE
❑ Yes
[] No
❑ NA
❑ NE
12128104 Continued

Facility Number: $Z — 36 ( Date of Inspection lz-13-o7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(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
[ ] No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EX 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
[;5 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 q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Sev - 4� �Gra eJ �ie � IZy �- O/S _ Bu-wu � . S G. Avt'-%J. Fts,-,(dR's-&4
13. Soil type(s) —T-ow.0.L�ay.11L-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 7No ❑ 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 �5 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes (QNo ❑ 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 iti Z _J CAS Phone: q10, 4V33. 3 3 O 0
Reviewer/Inspector Signature: Date: I Z - /3 - ZOO 7
12128104 C'onhnued

.a
Facility Number: $2 -:3(0l Date of Inspection t z.'r3-Oi
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes m No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E ] No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q 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 fait 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 ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qfl 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
[�9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
m No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
m 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
[�INo
❑ 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 ReviewcrAnspector 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
R No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

jib
_ a W Division of Water; Quality
Facility Numbed '� (D j 0 Division of SotJ and Water Conservation
0 Other Agency.. I
�a
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit M Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
I a
Date of Visit: I 1 1 Arrival Time: j Departure Time: EZ=1 County: Region: r'
Farm Name: QY'% 6_ I _ _ Owner Email:
Owner Name: r;z�� _ (of UST Phone:
Mailing Address:
Physical Address: 'Bucki o rr,
Facility Contact: rw `NW „ Title: 0 QrCr ho oq.i o
Onsite Representative- Integrator:
Certified Operator:'2 Operator Certification Number:
Back-up Operator:
Location of Farm:
T
D
Swine,'°Ca
?w ❑ Wean to Finish
❑ Wean to Feeder
.Weeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
'': ❑ Boars
-
❑ Other
Back-up Certification Number:
Latitude: E=1 n = ' = " Longitude: = ° ❑ t = u
Current Design Current
y Population Wet Poultry Capacity Population
II /rr II' ❑ La er �
❑ Non -Layer �
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Lj Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of>Structii
fli
Discharges & 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
1i NA
lPPNA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
10 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Fadlity Number: -
Date of Inspection
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
'**Yes ❑ No
❑ Yes �No
Structure
❑ NA ❑ NE
El NA ❑NE
Structure 6
Spillway?: Lies
Designed Freeboard (in): -u
Observed Freeboard (in): I -] i e aporled on Nov s�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑YesNo
NA NE
❑ El
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
ElNA ElNE
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
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�RNVo
❑ 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
❑yesNo
❑ 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. [9-Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN X PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind DL�P.r
Drift El Application Outside of Area /� l
12. Crop typeS s) cwre LAin -Sc�a-vt fQ-Z[ %& , � leAI US - .1k t-I _ S1 L� IUI-, , Fe-SOC P
13. Soil type(s) _' a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ 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 ❑ 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):
11, P u 1 - i `��e_ 0o5--oca b� t�.� 6 . Wo4e `
ate, f 4.9 wo-s ueiua fC A,' I
Gr )qsed on h ,5Ar j'W
f(f co r-rs /+ rr -Pa!
Reviewer/Inspector Name I "..-A kl�Sl i NG 0 Phone:
Reviewer/Inspector Signature: Date: 2
Page 2 of 3 12178104 Continued

Pacility Number: Date of Inspection Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ElNA ElNE
the appropriate box.
❑ WUP [I Checklists ❑Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 4No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes )4No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
`KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IXNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
�F A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
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
'PANo
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1� No
❑ NA
❑ NE
:Additional :Comments and/or Drawings:
SI wj
�kore� 1
wrlev has dvoqu t a" A_r m un4 l ht Can Lxe r
is , ID; d- -ko J, 4,, --,-P.,, . - (figr4c-
4e-cc--P ou - S-�r u c +u&j k-�r "oa r d -
�. Sure 40 LkS-e- nc L;-:�Qa-�e CknaPoy- a((
CpQLca-Lan s QN t�. i rF—ODC9.
C�Wneur P (ans 4c_-) r e- seed �'e Sc-UC . Also �1an S �u
COY14UL4 Cn-McCX Qcno n nC S o-,Ad PD4en 4:o
i rn o
Page 3 of 3 12128104
t ncAa l red LaP✓a1, an 5, S�ern . i) A (ao �r` c Lxo .

Facirity Igo. k) 10 Time In 10 Time Out Date all
Farm Name Rcn n L, a 14 e.: ! Integrator
Owner 1i . ��f-(k v _ Site Rep .� Q
Operator 2 clm4gg No. 1 L 6_ rf
Back-up No. _
COC Circle: QGen;eralor NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow -finish'
Feed - Finish
600
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design j q Observed '
Sludge Survey a0� Calibration/GPM 1 A r
Crop Yield Waste Transfers Td °C /
Oa�h�
Rain Gauge Rain Breaker
Soil Test p- PLAT —M f Wettable Acres
Weekly Freeboard �J� Daily Rainfall
Spray/Freeboard Drop
Weather Codes
1-in Inspections—,`�
Gt k:�
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
a cclltl ►a �� �. q
Cl
120 min Inspections
Pull/Field
Soil
Crop
Pan
Window
r c
/all-
D
mu
d
0
I Zo
-131

n
Dtviston�of �'ater,Qualst}
===Vacifity—y, r g� 3 0 Divtsion of Sod and V4Qater Conservation
Other.Agency
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: G G-Oyu Arrival Time: i .s p Departure Time: County: �� gsart Region: w�
Farm Name: m � Owner Email:
Owner Name: C,zrief Yltone: —0- 4U.2 3-2 4
;Mailing Address: e eit p.,
Physical Address:
Facility Contact: IQan.d •,e Cr,,- Zen C Title:
Onsite Representative: a n Ile
�,-
Certified Operator: Xo RAG Car�rr
Back-up Operator:
Phone No: 110 - 990-20;?
Integrator: A-ra y jerwwn
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = = Longitude: = ° ❑ , ❑ ,f
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
J❑La er
E1 Non -La ei
Dry Poultry
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`?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (Ifycs. 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 Dlo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
❑NE
El NE
❑ Yes
0NoElNA
ElI Yes
,
wo
❑ NA
❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9158
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: J�"
Spillway?:
Designed Freeboard (in): K; 3
Observed Freeboard (in):a�"'' _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,.,
O
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[ Io
❑ 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
[-5o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [fIo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [944'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
5` 4, ,?iG /-If II/7'y '7' f_7a 7S"
12. Croptype(s) B991AS�,1, S50r& v.n ' S�o.,-,�r-rsrs�-r— geuC�e_ JIMP,
13. Soil type(s) 2e.•,��Qw Ai Lvn Ala
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'z❑ Yes
❑ No
❑ NA
9<E
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[ 14E
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
❑'1Qo
❑ NA
❑ NE
M1. Cal n figs I -A.1 IOw GtGrs 4.l FtS t yc T l ,
Reviewer/Inspector Name �a� �flr� Phone: l/O- 4/8G -&7� ��wv
Reviewer/Inspector Signature: Q Date: - 0 S

Faeffity Number: — Date of Inspection -G-off
Required Records & Documents ,.,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElL1'IVYes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑'1 o ❑ NA ❑ NE
the appropriate box. ❑ "!ter ❑ C fists ❑ Domes ElM❑ O
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Imo ❑ NA ❑ NE
❑ ie*­- ❑ weekly Fieubc ❑ vfwstnigsis ❑ Seib Aua3ysis ❑ ❑ Certifica Win
❑ *ainf� ❑-&tacking ❑ d ❑ 1 ❑ s ❑ w4aawf- ede
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑. -3Io ❑ NA ❑ NE
❑ Yes
[-fo
❑ NA
❑ NE
❑ Yes
P o
❑ NA
❑ NE
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
EJ-5o
❑ NA
El NE
ElYes
ElNo
ElNA
EKNE
❑ Yes [;I<o ❑ NA ❑ NE
❑ Yes Ol o ❑ NA ❑ NE
❑ Yes 2"No ❑ NA ❑ NE
❑ Yes 9-190 ❑ NA ❑ NE
❑ Yes [;11ro ❑ NA ❑ NE
❑ Yes Moo ❑ NA ❑ NE
A'�ddthonals'C*rnents and/or Drawings
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �� 1 Dam of Visit: �j`! - r> Tune: r O
Q Not Operational Q Below Threshold
®•Permitted Q•Certif ied w © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: �a?� �s : P_ rimer _ County: set O!f
Owner Name: _W ��Qea� 7tL/�. _ Phone
/No:
Mailing Address:._ 3 � (� � _�,L Gx ✓r� /C d[_ -f A rr G I I S , Ale S!' 1Vz
Facility Contact: Title: Phone No:
Onsite Representative: R iLl-I , G <-q . je-Integrator: %yi t=9 4 j
Certified Operator: C.l[ t Operator Certification Number.
Ope _.
Location of Farm:
04SVvine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` " Longitude • � Du
Pbeharg &, Stream ImPaCt5
1. Is any discharge observed from any part of the operation? ❑ Yes ❑-Ko—
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q'1 0
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Erl4o
c. If discharge is observed, what is the estimated flow in gaUmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 9-N-0
2_ Is there evidence of past discharge from any part of the operation?, ❑ Yes M No
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes BNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑-I�o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
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 [}14o'-
seepage, etc.)
6. Are .there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes O No
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 maintenancerimprovement? ❑ Yes [ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes O NNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 2'Fio
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Foe Ground ❑ Copper and/or Zinc ? v
12. Crop type J r, aif G r 4 Sam �12 - -
13. Do the receiving crops differ with those designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
Management Plan (CAWN P)? ❑ Yes
C1 -M
❑ Yes
Edo
❑ Yes
B-Ko-
❑ Yes
ETFo
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes EKG
-
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 S-NGv
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E3No
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 BIg0
Air Quality representative immediately.
�- .
+Co�mts {rr�errygaesteoa. auy�aas�ias �d/or aayt �Y
`-'€
Lice 1 of ba i . {tee as p k geld Copy Final Notes �ww
e4dee 0441 S�v#,47 eo1 �a,� 4 eeolj 7tA-'t year, IQ%east wzarn.�>ler w+.o.�
SRO tar. Ft J n e e ra
Hw
s "-7 �. �?-fig" -.--�-•..
Reviewer/Inspector Nam � ;740., nlm-
ReAewer/Inspector Signature: Date:

Facility Number: -Z — Date of Inspection
&gAred Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑-Pik
22. Does the facility fail to have all nents of the Certified Animal Waste Management Plan readily available?
(iel�iTJs'c itsOesigk etc.)
;S?,
❑ Yes
[��
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O No
❑ *91FAppha»n ❑ d ❑ Z AMLIAUrm
:2•7 3—i 3.1
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ey Nb
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
B-1q0
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
EWOF
27. Did Reviewerftspe= fail to discuss reviewlinspection with on -site representative?
❑ Yes
mwo-
28. Does facility require a follow-up visit by same agency?
❑ Yes
DNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑'Nly—
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 04?0-
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103