820365_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

il
I:%,
type 01 visit: ScMompliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — —/ Arrival Time: Departure Time: � County: vLRegion:
Farm Name: L3 a v, ra Owner Email:
Owner Name: wet rr'fa`L,1 r -^TFT �---- Phone:
Mailing Address: "- S U-) T, L V � (' ` —�
Physical Address:
Facility Contact: ,r Title: 6L4 �J rl
Onsite Representative: G (�%!�� Integrator:
Phone:
9 r�
Certified Operator: T Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes SNo ❑ NA ❑ NE
❑ Yes
Design _ Current -
❑ NA
Design
Current
DesignCurrent
Swine
Capacity Popp
Wet Poultry
oa grif-VIMPAR.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
I
Calf
eeder to Finish
%/
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
r :D . P,oultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts Non -Layers
Boars
Pullets
Beef Brood Cow
- -
Turkeys
Other
, ,F
TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes SNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes RLNo ❑ 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

. 1«acili Number: - 6_1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f ,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C �
Observed Freeboard (in): � (l '7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes K! No C] 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 2INo ❑ 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 .g No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No [] NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1,1;�tNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �z In a j e- /7' v r-'- �
13. Soil Type(s): jyK) A- I 2t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 11--1 No ❑ NA [–]NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No El NA E] 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 g No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 _qNo
❑ 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 A No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - 6 I Date of Inspection: `
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes O_No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signator
Page 3 of 3
❑ Yes
No
❑ NA
0 NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes [Q No ❑ NA ❑ NE
❑ Yes JEq No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
[-]Yes Q No
❑ Yes Pq No
❑ Yes LEf-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
✓ 4 �QW W'2 j!/�
Phone:
Dater17
21412015

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! / Arrival Time: /p ! !S Departure Time: O County: Se,,,4rjn Region: 1a
Farm Name: �3TJ��dY S Fa L4- LLQ- _ Owner Email:
Owner Name: rr-e j fir• Thi Or n 104 f Phone:
Mailing Address: '% OR S w fyj e /"..I7r1 NG aka 8
Physical Address:
Facility Contact: Gry ] rn A n Title:
Onsite Representative: S a
Certified Operator: xl'fer!
Back-up Operator:
Location of Farm: Latitude:
Phone: J
Integrator: T/'eSfa-G e
Certification Number: ] tip j P1b�
Certification Number:
Longitude:
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑"No ❑ NA D NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
Design Current
+Design
Current
Design Current
Swine F
Capacity Pop. s
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai ry Cow
Wean to Feeder Non -La er
Dairy Calf
eeder to Finish Ll o& s` - M
Dairy Heifer
Farrow to Wean`--'
Design
Current
Dry Cow
Farrow to Feeder
D , �PLouI
_Ca aeity
Po ,
Non -Dairy
Farrow to Finish,
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
OtWE- � ��"
Turkey Poults
_
Other 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 (gallons)?
❑ Yes ❑"No ❑ NA D NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No DNA ❑ NE
?. Is there evidence of a past discharge from any part of the operation? ❑ Yes D -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑1No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility\amber: g, -z - 3(, 1' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7r7 '' 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑'No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[D -No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ED No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]'lQo
❑ NA
❑ NE
maintenance or improvement?
21. Does recorrd keeping need improvement'? If yes, check the appropriate box below,
Nolr 4od L7
1:1 Yes
El No
Waste Application
❑ NE
u.� 1-2 2
❑ ❑ ekly FrMbOft.d❑ 1h*-astt? }sis ❑ Soil Analysis
❑ e
ran e
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'No
❑ NA
❑ NE
maintenance or improvement?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E] -<o
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
�o
❑ NA
❑ NE
❑ NA
❑ NE
Page 2 of 3
❑ P*N ❑ P, ibs_ ❑ T-eta�❑ Fdanure15judgg_Lu1o_13=
Sod
❑ ❑E ❑
11
12. Crop Type(s): CoSlf-a!f d ertn tld& - LLY , S na 1l �r/Ga �'n - He,,.
13. Soil Type(s): IG A , & o 14
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes e -f' o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [0,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
[:]Yes
❑-No
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to tave all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
OWro
UP ❑£4x� [:]Design [] 44atps ❑
❑Other:
21. Does recorrd keeping need improvement'? If yes, check the appropriate box below,
Nolr 4od L7
1:1 Yes
El No
❑ NA
❑ NE
u.� 1-2 2
❑ ❑ ekly FrMbOft.d❑ 1h*-astt? }sis ❑ Soil Analysis
❑ e
ran e
❑ Weaclser£a
❑ fttUf3+i- ❑ S+M�, ❑ U+)f�-� ❑ -
❑
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E] -<o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[D'No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Wicifity Number: Y2 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Y-30-16 ❑ Yes [✓]'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E4ivo ❑ NA ❑ NE
the appropriate box(es) below.
y_.73 -,s
❑ rvey ❑
❑ - pian s u
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 [B -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA �
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑rNo
❑ 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
�o
❑ 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
62<o
❑ 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
E3 <o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ejj<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�Ko
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I5 J o
❑ NA
❑ NE
-'70 I0IcpsP t' /r, 14
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S4vGv CU>r%rdl- ►n 4 'O/}
Reviewer/Inspector Name: A C, P M 61-1 „ R4.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `1/v -Y 3 3 -"33op
Date: Z! j
2/4/2015

(Type of Visit: QJC�outjne
cc Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time:p l7 Departure Time: County: Region:
Farm Name: ��ry', A P7#11 Jf-p2�cdlrn % /� Owner Email:
Owner Name:/i' /� G'a✓"��r� Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
Onsite Representative: �itd�r� Integrator:
Certified Operator: 1 e/ -r-7 ca f `�%� Certification Number: 4&091
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Curren#
Capacity Pop.
Wet P.;oultry `
Layer
Design
-Capacity
Current
Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to FeederD
7
'i
. Poul
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke Points
Other
ate.._.
.
Beef Brood Cow
Other
Other
D_ischarzes and Stream impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes C3 -No [] NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes gEg No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 214/2014 Continued

Facility Number: - S Date of inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
' 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Eg Yes
❑ No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
❑ NE
Identifier: 6 ` k�
Spillway?:
Designed Freeboard (in): !19,
�
Observed Freeboard (in): Z�� / b _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
[] Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
~
7. Do any of the structures need maintenance or improvement?
❑.Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RA No
E] NA
E] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[4 No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/ Window ❑ Evidence
'o-fWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
❑ NE
i
13. Soil Type(s):'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA E] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

[Facility Number: - Date of Inspection: � l
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 E 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 EZ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EZNo
Other Issues
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
MNo
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
12 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
CONo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
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
gjNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Commen#s .(refer to question ft Explain any YES answers and/or_ any additional recommendations or any other comments:
Use drawings of facility to better ex law -situations use additional: pages as necessity).y °
7�;V_ 1-5 a,;I- 17-z'
39
l
/rlauJ !-� vim- L�s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: E
Date:
2/4/2014

Type of Visit: (B'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ey, routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: LLQ Arrival Time:Q c'� Departure Time:' (� Countyry� Region: > (7
Farm Name: ( rn, A n PL t!D $ Owner Email:
Owner Name: �V Phone:
Mailing Address:
Physical Address:
Facility Contact: 7-r-- 1 (�Ge�<•� Title: ✓' Phone:
Onsite Representative: 5'e4'e_ Integrator: /` u
Certified Operator: - Certification Number: r V00r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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 DWR)
❑ Yes E(No ❑ NA ❑ NE
❑Yes 0 N 0 N 0 N
E] Yes 0 N ❑NA 0 N
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 [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
Design Current
Design
Current
Design
Current
Swine
-"Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
O� 1
y ........
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P,ou1
Ca aci
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rTBeef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
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 DWR)
❑ Yes E(No ❑ NA ❑ NE
❑Yes 0 N 0 N 0 N
E] Yes 0 N ❑NA 0 N
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 [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

f FaciliNumber: - Date of inspection: ,090
t
1 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):
Observed Freeboard (in): g L
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes [0 No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[5g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[27No
❑ 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
g] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P3�.No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /c ��"�� /
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,'Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA [] NE
❑ Yes [] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes ' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g 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 Frecboard ❑ 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 JZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes 5q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

Facility Number: jDate of Inspection:
1
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 fust 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 ® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes fSj 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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes 0 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted W" cause non-compliance of the permit or CAWMP?
11
❑ Yes ZL 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 g No
❑ NA ❑ NE
Comments (refer to question #) Explain any YES: answers,and/or any additional recommendations or any other coinneents
Use drawrngs.of facility to better explain situations(use additional pages as necessary). ' `t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�a—"7i -33C'C>
Date:
2/4/2014

i
iv"ision of Water Quality S --�-
FacilityDivision of Sail aad Water Conservation 2M_MU--/3
J Other Agency
Type of Visit: Qompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ArrivalTimed Cf.oD 1 Departure Time: County:
Farm Name: &n pi 11 e) p 65/'P.* Owner Email:
Owner Name:/'r'y /7? Cat- 725- Phone:
Mailing Address:
Region:
Physical Address: �J
Facility Contact: d+" �-�i' Title: �u/'hr'� Phone:
Onsite Representative: �'� Integrator:
Certified Operator: S'ct Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes �To ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Callo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 2/4/1011 Continued
Design Current
Design
Current
Design Current
Swine
Capacity' P�o:T
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current_
Dry Cow
Farrow to Feeder
D . P,oult .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
jBeef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other
_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes �To ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Callo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA [] NE
of the State other than from a discharge?
Page 1 of 3 2/4/1011 Continued

Facility Number: - Date of Inspection: - ` -- /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g 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?:
❑ Yes
y No
Designed Freeboard (in): /
❑ NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):_ 3�
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Co No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes E[No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 23 -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): p -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes t0, No E] NA F] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E�LNo [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
y No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[�jkNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rMNo
❑ NA
[3NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F�SLNo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes & No
E] NA ❑NE
❑ Weather Code
[-]Sludge Survey
❑ NA ❑ NE
C-] NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number: fr- 6 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Wo ❑ 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 tj�[ 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 ® 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
5INo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
O No
❑ 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
IM No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[gNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
R No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[S No
❑ NA
❑ NE
Comments (refer to question: Explain any YES answers and/or any additional recommendations or any other,comments:-
Use drawings of facilrtyit -better explain situations (use additional pages as necessary). ..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /rte f
2/4/2011

t
■ ype vi visit; vrt-ompuance inspecrnon v vperanon xeview V structure Evamanon V i ecnmcal Assistance
Reason for Visit: 04routine O Complaint Q Follow-up () Referral O Emergency O Other O Denied Access
Date of Visit:rrival__Time: ;"/s Departure Time: t! County: �cx.�t•—
Farm Name_ f. n r► �T77E2U d !� 7—/,-2- Owner Email:
Owner Name: // �/"r' y %'yJ G'��.�� Phone:
—ems- -
Mailing Address:
Physical Address:
Region: Z[
Facility Contact:, �rYy ��r Title: `1 G!J/r"— Phone:
Onsite Representative: Integrator: ll�
Certified Operator: _ s Certification Number: �Py 0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design
Current
Design
❑ No
❑ NA
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
JDairy
Calf
eder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dry P,oult ,
Ca aci
P,o P.
—Dry
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uther
Turkey Poults
ML_Lther
Other
,.:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D?]_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes] No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

FaciliNumber: - 3 Date of Inspection: 1
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
Vj, No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t — . 6-- '
Spillway?:
Designed Freeboard (in): — 1
Observed Freeboard (in): .4E ;7-_ 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes S No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ®. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
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 Jallo
❑ 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) Zr%'��.:�Se�s6�� 5 / l�rr`rn wee / D l S r
13. Soil Type(s):
W 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes r,No ❑ NA E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes a 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 [0 No Q NA ❑ NE
[] Yes ® No ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the 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 [2!�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes C.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 U, No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Lallo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - I I Date of Inspection: "
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3Yo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: _
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 r&No [DNA [:]NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [� No [DNA [:]NE
[:]Yes EgNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any..'other ccommments:
Use
"drawn of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g/Q :]�(E-,350�
Date:�-
2/4/2011

I.
ivis�ankof�Water'Quality � ,
Facili Number - O Division of Soil and Water Conservation
� 3 �
- .Q Other'Agen�cy'
Type of Visit:() -Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: -�- //A Arrival Time: p; pa Departure Time: County:.p
Farm Name: V z/Yi TT rt r -L }4p t,= Fae,- — 7--I .�— Owner Email:
Owner Name: V /' •L, ��Cf 'r/ Phone:
Mailing Address:
Physical Address:
Region: ,l7
Facility Contact: Er -Lr y fir/ f `r�,� Title: agI4 Phone:
Onsite Representative: '�-- -- Integrator: �/'
Certified Operator: Certification Number: �D 08fi•
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharzes 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)?
[:]Yes Eg-.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
$Design Current
Design -Current
Design Current
Swine Capacrty Pop.
Wet Poultry
"!Capacity Pop
Cat#le Capacity Ppp.
Finish
Layer
Dai Cow
Feeder
Non -Layer
Dai Calf
Feedero Finish
p
3 �, ``
Dai Heifer
o Wean
EFarrow
DesignnCurrent
D Cow
o Feeder
D , Poultry
5*
Ca acltv�,kiry
Non -Da
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Puliets
Beef Brood Cow
Turkeys
OtherITurkey
?:vs
Poults
Other
LjOther
Discharzes 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)?
[:]Yes Eg-.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: jr6, Date of Inspection:
❑ Yes
[0 No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
❑ No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ` .3-o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El No
❑ NA
❑ N1✓
(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
[N 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R] 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): /)o �f � }
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes allo
❑ 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 Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej?[No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facifity Number: - b Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
I❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
® No DNA ❑ NE
[g No ❑ NA ❑ NE
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Z No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 10 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 CK No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 UgNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [a No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F2�[No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9VVi- / _T-- - T2pC>
Date:
2/4/2011

rype of Visit Q Compliance Inspection Q 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: / /D Arrival Time: fJ Departure Time: jw County: R - L_ Region:
Farm Name: Vaj�lei s 1 n 41)", Owner Email:
Owner Name: _ (�� ✓ r 'f >�C f�`c✓- Phone:
Mailing Address:
Physical Address:
Facility Contact: _T�'/y Title: /�.�+� Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ I =44 Longitude: =0=.
e❑. 0
tl
Design Current
Design Current
Design Current
Swine Capacity Population .
Wet Poultry Capacity Poplahon
Cattle Capacity PopulafI
tion
❑Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Yes
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish o L
-
❑ Dairy Heifer
❑ NE
❑ Farrow to Wean
Dry.Poultry .
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -Dairy
❑ No
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Yes
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ NA
❑ Turkeys
other than from a discharge?
Other
❑ Turkey Poults
❑ Other
10 Other
Number of Structures:
Continued
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
NA NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
91No
❑ NA
EINE
other than from a discharge?
12/28104
Continued

Facility Number: Date of Inspection L
Waste Collection & Treatment
13. Soil type(s) h p/*
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9,No ❑ NA EINE
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:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Spillway?:
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
Designed Freeboard (in): J _
g No
❑ NA ❑ NE
Observed Freeboard (in): _ Z9 3 '36,
❑ Yes
ANo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(9 No ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo ❑ 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?
J4 Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo [:INA ❑ 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
21No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D,No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
O -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)ki r JCY
13. Soil type(s) h p/*
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IM 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
g No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ NA ❑ NE
MFUR-
Comments (refer #o questeoda#) =Explain any YES answers andVor any recommendations or any other camments.
Use. drawing of facilityEolb'etter-explain situations `(use: addtional;pag s asgecessaty)
Reviewer/Inspector Name} ' '` = Phone: 9'7O
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El other
❑ Yes S -No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain inspections ❑ Weather Code
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 CAWMP?
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
31. 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
9LNo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
L'No
❑ NA
❑ NE
❑ Yes
JgNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
C -No
❑ NA
❑ NE
❑ Yes
(-No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
UE�No
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
12/28/04

IF
f
L
Type of Visit G'Gomplia ce 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:;2-i
Arrival Time: . �Dl� Departure Time: D - County: Tom" Region:
Farm Name: I/:- i ,?ff11 _ Djt �dr�i 7 Owner Email:
Owner Name: IraPhone:
Mailing Address:
Physical Address:
Facility Contact:� -COLYb— Title: 67G161,2 if Phone No:
Onsite Representative: 5== Integrator: at�
Certified Operator: a`' -Q— Operator Certification Number: qzCd>b
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I ="
Longitude: = ° = I ❑ u
Dischh es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
Design Current
Design Current
Design Current
Swine Capacity Population
V4'et Poultry C+opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
19 Feeder to Finish D (v j
❑ Yes
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
El Non -Layers
El Beef Feeder
❑ Boars
1:1 Pullets
❑ Beef Brood Cowl I
❑ NA
❑ Turkeys
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
❑ Other
❑ Turkey Pouits
IQ Other
Number of Structures:
❑ NE
L
Dischh es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ 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
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Z No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — 34Sr Date of Inspection
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P5No ❑ 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): /Z
Observed Freeboard (in): ,7/ ,,K
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.) ❑Yes �No [I NA El NE
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? ❑ 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 ® 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 SNo ❑ 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)
13. Soil type(s) NQ k / C5-6
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
�&NO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
J3No
❑ 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
O -No
❑ NA
EINE
( ,. as in endabons or anyofhe m
p
Comments refer:to uestion Eit lain anv YES anst►ers and/or any recomm Wer."co
Use draydngs of facility to better explain situations. (use additional pagesBess j
� r ram &'3' lVew
Reviewer/Inspector Name %��u Phone:
Reviewer/inspector Signature: Date: 971 -
12/2$/04 Continued

Facility Number: - Date of inspection g
4 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Z 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 [I 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CaNO
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
29 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
ERNo
❑ 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
[3 No
❑ NA
❑ NE
General Pemtit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C -No
❑ NA
❑ NE
12%28/04

0
Type of VisitCoe Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �outaine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ,� County: Region:.
l
Farm Name: rz n Hy Fa '-Pym 7 --Id2 Owner Email:
Owner Name: 7-e- rr Y� �� r r'� Phone:
Mailing Address:
Physical Address: _
Facility Contact: fir` y r� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number.
Back-up Certification Number:
Latitude: =0 =
c= 6 0« Longitude: 0°= i
it
-11 I
Design Cprreflt
_
Design Current Design Current
❑ NE
Capacity P,opulan
W P� ry
Capacity Population Cattle Capacity Population
to Finishto
7�ean
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
Feeder
❑ Yes
❑ Non -Layer
❑Dai Calf
❑ NE
Feeder to Finish
Iii- �
Dry Pv_ultrT
❑ Dai Heifer
❑ D Cow
❑ Farrow to Wean
❑ Yes
❑ Farrow to Feeder
❑ NA
-`�`
❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Yes
❑ Farrow to Finish
❑ NA
❑ Gilts
❑ Boars
❑ Yes
JSNo
❑ NA
❑ NE
Other
r
❑ Other
h.
12/28/04
Number of Structures:
Discharges & Stream Impacts
❑ Layers
❑ Non -La ers
❑ Pullets
Turkeys
s
❑Turke Points
El Other
1. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ 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
�o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JSNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: 96;1--13 Date of Inspection
1
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 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): / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ 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? gYes []No ❑NA [:INE
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 ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
9
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ERNo
❑ 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
tR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ NA
❑ NE
enr7'in v , GSD r f<► 69v'-, bW, �/x-� �u� 470_111� .
Reviewer/Inspector Name j Phone:/D3 nr-->
Reviewer/Inspector Signature: Date: /
...b- . __,. ,

' Facility Number: 3 Date of [aspectioa °
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C&'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 ®,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
[Z 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
C,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
CKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawmgs . Sw
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

ivision of Water Quality
Facility Number 3GSr O Division of Soil and Water Conservation
UZI O Other Agency
Type of Visit �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: C_?SAF�9;7
❑ No
Arrival Time: ,'DCS Departure Time: 1% SDA County:
Region: I�K a
Farm Name: -9e-1-1
; e1+nrl.
f{y ,faun 7Owner Email:
❑ NE
Owner Name: _r/'
sz rtcl Phone:
❑ NA
❑ NE
Mailing Address:
Physical Address: 1
Facility Contact: Title: Phone No:
Onsite Representative: Sass-�- _ __ Integrator:
AV
Certified Operator: Operator Certification Number: r�+�ae
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede,
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 0' = Longitude: =o =]' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�:: 1 4=��]
❑ Non -Laver
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stockci
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ®I
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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;@ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
0 No
❑ NA
Waste Collection & Treatment
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IN No
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): 147
Observed Freeboard (in): Y3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
KNo ❑ 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
[3 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
D§ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9 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/WindDrift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /yp7f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IN No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
C,NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
IN 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):
R
All d0 'S 1
Reviewerllnspector Name Phone:/1a—y.33-33D0
Reviewer/Inspector Signature: Date:� v?D�7
12/28/04 Continued

Facility Number: S — Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? D,Yes *No Ll NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fgNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
M -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
2,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[XNo
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D(No
❑ NA
❑ NE
2&
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[gNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9LNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

f Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
iReason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: ��?4�b Time:
Facility Number $a .' (o S
Q Not Operational Q Below Threshold
}� Permitted (p Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ..------� --• ••••
Farm Name: ...: r. ±" i __. „........ N.4 �.�– �� •• w, -........................... County:.........5 �..,. �hP.� ........ 1.12 ° ..
Owner Name:.. _ q nt C.'_-�'__' _ ...... Phone No:
Mailing Address: arr
.( i J s~ JIL_ – = - -- - — &/' l r! 4M .! �._. _ _ . _ .. .a &'f'i
Facility Contact: _ __._._. _..... �.� Title:.. _.. .. �— Phone No: .......___...-- -
Onsite Representative:... c i..... G,G.�r� _ _ Integrator: �r s� 4F �: w,
Certified Operator: S,e;r *•, .............. - ,_........... __.......... .._ Operator Certification Number: •° ��
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 'GL Longitude • 6 "
. _ Desegn
Swine
Wean to Feeder
Feeder to Finish L4 D 6 S
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
IFI Boars
.. Number °!.Lego
g- Non -Layer
Other
E
J j[] Non -Dairy
= TotaLSSLW
Disclimes & Stream I_ mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes Cj No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [g No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes] No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes] No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier �_.__ ... ................ _._ ...
Freeboard (inches): 3 (o
12112103 Continued

�Facilio Number: &.2 -- 3 a S -
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
11- Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ea S C3 ZaSrn S D ✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes [jj No
c) This facility is pended for a wettable acre determination? ❑ Yes P No
15. Does the receiving crop need improvement? ❑ Yes ❑( No
16. Is there a lack of adequate waste application equipment? [:]Yes A] No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONo
Air Quality representative immediately.
Comments (refer toguestwn ) EzpIatn any i ES answers and/or any.reconuneada#:oas or•any offer comments _
� ys.�-• � t,".Y. `�' � C .._ �'.`r i`] ��+�F,�„ - - �.." x.215• -'Y, -.. �y ,�.-....rte .i^ ' -�
,Use drav of fact7ily to liettei ezglarn s tuatra : (dsehanatpages as necessary) m Wield Copy ❑ Final Notes 7;y
Re viewer/inspector Name'r.
Reviewer/Inspector Signature: Date: yrs p�
12112103 U r ✓ Continued

Faciliiy Number: ga —30,',S -j Date of .Inspection �%a'i
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (j No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ® No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes PJ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes EffNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) "Yes ❑ No
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes M 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 NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm [gCrop Yield Form ❑ Rainfall ❑ Inspection After V Rain
[� 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ddlttORal Comment5`andlor Dravving5 _ = `
_ T
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m r_ �� � �cw n eCc�s Cn w -P lc� c �. � 0 10 i i �� ► ►1-� � r•-.�.�-, o .. �. �
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p�
ppr-TCr
C
C.toC"-,
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}' � 4 t -.t C, � 'y �- � � . �.[* � � Q P � 'fin , L � G tv..� +.�..� 4 S' ►�i N �
1�
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12112103