820377_INSPECTIONS_20171231

_AM
NORTH CARQLINA
Department of Environmental Qual

r'Ype of Visit: Qi rUompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: CRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 5 a L_At_ I Arrival Time: I Departure Time: i p County:s�_
Farm Name: $ fJ Nov f Owner Email:
Owner Name: J CLO Phone:
Mailing Address:
Physical Address:
Region: FIC
Facility Contact: ct.-c 11 S aL^C✓ c r.{� Title: Phone:
Onsite Representative: U Integrator: 'if U-19
Certified Operator: _ t ✓ CR_ CCA_ vi ✓\� JCW' Certification Number: 3 7 -
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 DW R)
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 ❑-115 ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
[:]Yes ❑No [4[ -NA ❑ NE
❑ Yes
❑ No
❑`NA
Design
Current
Design Curren-
..... -Capacity
W
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder i c�
at7S
Non -La er
Dai Calf
o Finish
Dai Heifer
o Wean
pFarrowtoFee
Design
Curren#
Cow
der
D , Poultr
Ca aci
P,o ,
Non -Dairy
o Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
s
Pullets
Beef Brood Cow
lurkeys
i
Mr
Ipe
Turke Poults
LLCther
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 DW R)
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 ❑-115 ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
[:]Yes ❑No [4[ -NA ❑ NE
❑ Yes
❑ No
❑`NA
❑ NE
❑ Yes
E]1" _o
[DNA
❑ NE
[—]Yes
'j -'No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: Z - Date of Inspection:
❑ Yes
[E'llo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Q No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E9 -15o-[:]
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D -N -o
❑ NA
Spillway?:
❑ NA ❑ NE
Designed Freeboard (in):
b
Observed Freeboard (in):
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
Q 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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
[U] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
[E31�o
❑ NA
❑ NE
maintenance or. improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3 Ko
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [, o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN p 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 3g& 0 r
13. Soil Type(s): t1jo-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[E'llo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g-fto
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0'i Jho
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Quo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D -N -o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
�o
❑ NA ❑ NE
26. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EJ -N-65
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0'i Jho
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
p Waste Transfers
❑ Weather Code
0 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
E5"No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EnlNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility umber: -3 7YJ jDate of Inspection: 4,e
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [c. o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes ED-1Qo ❑ 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 [EL -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 Q o ❑ NA ❑ NE
❑ Yes [9-1qo ❑ NA ❑ NE
❑ Yes EJNo ❑ NA ❑ NE
❑ Yes [:r—No ❑ NA ❑ NE
❑ Yes
[,a-hio
❑ NA
❑ NE
[:]Yes
Q'T�o
[DNA
❑ NE
❑ Yes
Q1G_
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
GamI(f-C,41OA- 9)-'�_6-16- 9S �� I
I to -- '::� o g - WS1
Reviewer/InspectorName: 13 t ll V�•ir�o Phone: $033-3337
Reviewer/Inspector Signature: LIMAIL Date:
Page 3 of 3 F 214/1015

I
c of visit: 4Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
son for Visit: (YRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: l `T 11 N I Departure Time: iJ� County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: c_C44(5. Title: Phone:
Onsite Representative: ! Integrator: o -[a " 5
Certified Operator: Certification Number: FrA02 .
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desi n Current
g q
�Des�g� n��Current
Current
- Swine
Cap r .
acrt Po
Yip• _
Wet Poultry
Capac�tvl'op._ `
EjjDesign
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
bo 6 %�
Non - Layer
Dai Calf
-_
Feeder to Finish
...
i -
r -
- �:,�-
^n
Dai Heifer
Farrow to Wean
—Dost
`,_
g Current
D Cow
Farrow to Feeder
D Poult ,, ' `
rye " ,Ca act }`°...Po"
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.
Turkeys
Other
—�
Turkey Poults
OtherI
L
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff5o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`? ❑ Yes ❑ No ❑'1QA ❑ NE
b. Did the dischame 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 E� NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E?Vo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

F.acili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ed-Na-0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-KA ❑ 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
[�''l�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
Q'1 Imo
❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[:j"No
❑ NA
ON E
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
- -
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3&o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
['No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1� 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): { w-rAeA 5c, C7
13. Soil Type(s): AIN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El"Nlo ❑ 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 ❑ Yes Ea'l`lo ❑ 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 []TNo ❑ NA ❑ NE
❑ Yes E2,No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the 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 eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21417015 Continued

JFAcHity Number: V, - Date of inspection—. _
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I3'vO ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []r<o__ ❑ 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 [ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [31�o ❑ 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 E t ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Flo ❑ NA ❑ NE
❑ Yes D/No ❑ NA ❑ NE
❑ Yes
dNo
❑ Yes
0 No
❑ Yes
dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
C-a'44""o n ___
pt -1&
S14C 5��j , OFK t 4?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
t N ( Phone: cGy - 1 U— V 3 3 f
Date:,.Y 1
2/4!2015

tsk vt5 1 -- ��
Division of Water Resources
Maciliumber - �'J-] O Division of Soil and Wager Conservation Q Other Agency
Type of Visit: 97COompliance Inspection 0 Operation Review'O Structure Evaluation O Technical Assistance
Reason for Visit: tRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regto47�?
Farm Name: .� Owner Email:
Owner Name: '� t�� t1'jf�h Phone:
Mailing Address:
Physical Address:
Facility}
Contact:Title: Phone:
Onsite Representative: tl
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: VA 6 —_5
Certification Number:' 4 M
Certification Number:
Longitude:
� �_ " „Design Current
es
Current
Design CE=D
aign city
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder c u
Non-LMer
Dai Calf
Feeder to Finish
-
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oultr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood r --
Turke s
II
}
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)
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?
Page 1 of 3
[]Yes L-]< ❑ NA ❑ NE
❑ Yes [—]No [3NA ❑ NE
❑ Yes [—]No [:I'NA ❑ NE
❑ Yes ❑ No Eff'NA ❑ NE
❑ Yes 0i No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
2/4/2015 Continued

i�
Pacili Number: V,- Date of Inspection: s
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
Qplt�[] NA ❑ NE
[:]No 7 ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [t]'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
B<o
❑ NA
ONE
waste management or closure plan?
❑ Yes
ZNo
❑ 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
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]"No
[] NA
❑ NE
maintenance or improvement?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[fNo
❑ NA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
1 i. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes g�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
r /
12. Crop Type(s): J,J `C,TrN Q-J"t '5 b 0 -- -
13. Soil Type(s): t 1 OLS
14. Do the receiving crops differ from those Wsignated in the CAWMP?
[]Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[fNo
❑ NA
❑ NE
the appropriate box.
❑WUP F1 Checklists [❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ 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/[f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
E] NA ❑NE
Page 2 of 3 214/2014 Continued

It
IFaciNty Number: - 7 Date of Inspection:
`24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 UKO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? C]Yes [ No E]NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
CZ<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
dNo
❑ 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
[�(No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[!fLo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ 'No
❑ NA
❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 'amuAxe b
21412011

I WS Ll `" 2 1 S 131
Type of Visit: e'Com liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: a Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: h p Departure Time: County: Region:.
Farm Name_ �t¢✓ti'-.;Vy Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C', A.': a I AV"40 4 Title: Phone:
Onsite Representative: f ( Integrator: M e
Certified Operator: Ca Certification Number: f<
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
We to Finish
Des�gnCurrent
C p cityPop '
Wet Poultry
La er
Ilesrgn Ctrrent
Cap c tyPop §s_
Desi`,gr► Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
o
Non -La er
[—]Yes
Da' Calf
Feeder to Finish
f�',
;''
IIDesignCuqent
�' _
D ' Heifer
Farrow to Wean
''
Dry Cow
Farrow to Feeder
D a l;oul .Ca
"ach-
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
_
Beef Feeder
Boars
Pullets
Beef Brood Cow
k..
Turkeys
OtherU
Turkey Poults
Other1300ther
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 [Cjda ❑ NA ❑ NE
[:]Yes
❑ No
[fj-NA
❑ NE
❑ Yes
[:)No
❑ NA
❑ NE
❑ Yes
❑ No
dNA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
[—]Yes
Ej No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

FaCWty Number: - Date of Inspection: tM
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M_Na--­O NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No Lr7 A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L3
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes M�M ❑ 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 [y].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 �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes t G <o ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes B<O ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need ❑ Yes 21 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
0 Outside of Acceptable Crop Window ❑f Evidence of Wind Drift ❑ Application Outside of Approved'Area
12. Crop Type(s): ) U °ti'r`e S IGS
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
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?
Re uired 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 g3<o
❑ Yes �o
❑ Yes QNo
❑ Yes �To
❑ Yes E3-NZo
❑ Yes [ 1 0
❑ Yes E],No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E] -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Rainfall [:]Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes [E'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3'No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Fac`ai Number:- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
r'
o
❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑`No
❑ NA ❑ NE
the appropriate box(es) below.
❑ failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
[D No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
To
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D o
[DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E14o
❑ 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
To
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
t No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑'go
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�_No
❑ NA ❑ NE
Comments {refer to question ft Explain, any YES aaswers andlor!any additional recommendations or any other coma eill rix
x..
'' 3°h w
Clsedrawrn of.facih tobetter.:ei 6a� itdattons uie;adlitional'
N ty p_ ( pages as necessary' ;.
1''
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: LW—SJ J \
Date: J
2/4/2014
5
�
�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: LW—SJ J \
Date: J
2/4/2014

Type of Visit: G�'obtplianee Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: (,Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: c
Farm Name: --3 Owner Email:
Owner Name: �� �, �� V\_ Phone:
Mailing Address:
Physical Address:
c!
Facility Contact: (S (c ✓�l [U� Title:
Onsite Representative: rS
Certified Operator: yti u�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: &-:L _
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q. ❑ NA ❑ NE
a. Was the conveyance man-made? [:]Yes ❑ No LJ 9_A ❑ NE
K Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No to ❑ 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 I�No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued
Design` Current
Design
Current
Crrent
P
Swine
Pop.
Wean to finish
Layer
Non -La er
-
Da' Cow F::�
Da' Calf
Dai Heifer
Wean to Feeder
Feeder to finish
Farrow to Wean
Design
Curirettt
D Cow
Farrow to Feeder
D . P,oult .
Layers
Ca aci
Pio
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
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:
❑ Yes Q. ❑ NA ❑ NE
a. Was the conveyance man-made? [:]Yes ❑ No LJ 9_A ❑ NE
K Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No to ❑ 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 I�No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

[Facility Plumber:. Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EEji4u---D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [D -N* --J ] 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
[!" 1qo Q 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
2'5o�❑ 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
[9'No NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io ❑ 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 [ -1qo ❑ 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 Q❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): Gt-vw S V
13. Soil Type(s):
14. Do the receiving crops differ frorYK 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes La_N� NA ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes ❑-N-o— ❑ NA ❑ NE
❑ Yes ED-< ❑ NA ❑ NE
[:]Yes D -Ko �❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2 -Go ❑ 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 No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0-bie, ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ET<o ❑ 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? ❑ YesZoo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3-fTo__' [DNA ❑ 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 [3<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 2dgb ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) I
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [—]Yes To ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E3<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[—]Yes N'o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑TIo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use win S0 facility. to better explain situations (use additional pages as necessary).
Gr"(t6raAl0✓1
- --7- 6 - (),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ph I L' K 3.33
Date:
114/2011

JType of Visit: 0,C��omppliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
(Reason for Visit: (3Woutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: alp a Arrival Time: Departure Time: QQ: O County:
Farm Name: Owner Email:
Owner Name: �a F FF W ARREn1 Phone:
Mailing Address:
Physical Address:
Facility Contact: _ UPXS S __�g{Z6xL L1( ^ Title:
Phone:
Region: 10go
Onsite Representative: S';'. Integrator: f uizok4 ro
Certified Operator: Certification Number: Mise a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees 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
Design Current
❑ NA
Design
rr
@n"',
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
op. `
Cattle Capacity Pop.
[:]No
Wean to Finish
❑ NE
La er
Dairy Cow
Wean to Feeder
Z100 `IO
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P,oul.
Caachy
Po
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turke Poults
Other
Other
Discharees 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
[g,"No
❑ NA
❑ NE
❑ Yes
❑ No
[l�'NA
❑ NE
❑ Yes
[:]No
[PNA
❑ NE
[:]Yes ❑No
❑ Yeso
❑ Yes No
EBNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: 13R - 37 jDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E] Yes [gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No VNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
0;3"'No
❑ NA
❑ NE
❑ Yes
E?(No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [3CNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2"'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 [;j"No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a'llo ❑ 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):g{iLr�.30A-
13. Soil Type(s): a.v lr
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ o ❑ 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 ❑ Yes [�Io ❑ 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 dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�No
❑ NA D 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
[g"No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
[D�`NA ❑ NE
Page 2 of 3
214/2011 Continued

w �
Facili Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes + No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [✓"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [9'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ❑ No [v"NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ► No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field 0 Lagoon/Storage Pond ❑ Other:
[:]Yes ENo ❑ NA ❑ NE
❑ Yes ❑�No ❑ NA ❑ NE
❑ Yesl,'N' o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C9"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [t"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ER/No (DNA ❑ NE
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: LkN
214/2011

4/1-110/b
Type of Visit: ®'Coroutiffle
ce Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Sri!`- Region: Iii
Farm Name: Owner Email:
Owner Name: 7,,-- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: /`ro. --3 Phone:
Onsite Representative: Integrator: 4—,
Certified Operator: Certification Number: Qv�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desgn�C.urren#R __ Design CurrentDesigu C►orient
Swine Capacity Pop Wet PouEtay Capacity Pop Capacity P.
r r
RIM
Wean to Finish r" Layer
Dai Cow
Wean to Feeder /GQ Non -La er Dai Calf
Feeder to Finish 3''� Dairy Heifer
Farrow to Wean Destgu�Current ` D Cow
Farrow to Feeder D P,oult . Ca ac"Po3
Non -Dairy
Farrow to Finish I Layers I U. Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
arm
`
Turkeys
h
Turkey Poults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
to
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
531�A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
0 Yes
❑ No
J3'1gA
❑ 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
&3<A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
C10
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2011 Continued

lFacility Number: -31717 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Bio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No E NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ZZ
Observed Freeboard (in):
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 �o ❑ 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
2<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0;?
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
0
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E44o
❑ NA
❑ NE
maintenance or improvement?
❑ YesNo
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Va
❑ 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).
i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2Ia ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes Bio ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes A10 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
TTN.
❑ NA
❑ NE
1$. is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
0
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'1
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesNo
❑ 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 12<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No &KNA ❑ NE
Page 2 of 3 214/2011 Continued

Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes OR'< ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P4. ❑ 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 R<O ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes ❑ No IA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[a'5o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
L2,<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
2<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
2rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�j<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�Ko
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:rj/p,�
Date: (P 1I
274/2011

ir�alS �—OS— Z4/D
Type of Visit ()-Cbimpliance 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: %'2Z-/O—Arrival Time: 1 : ,3� Departure Time: l ,5� County: g Region:
Farm Name: el Owner Owner Email:
Owner Name: D �a y �u ��. -_7A/ ` Phone:
Mailing Address:
Physical Address: l
Facility Contact: C(AJ � r.S 8a VL�"<-� Title: f `'"t - ��• Phone No:
Onsite Representative: integrator: Co a Yr C
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = =I =" Longitude: = 0 = = N
Design Current
Design C►urrent
Design Current
Swine Capacity Population
❑ NA
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder MOD 0 1
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
[:1
El Farrow to Finish
La
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
ues
❑ Beef Brood Cowl
❑ Turkeys
Other
El Turke Poults
❑ Yes
❑ Other
❑ Other I
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
15<0
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[I Yes
El No
��
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
El Yes
El No
,[��'TNA
I_TNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
, ��
Ej
❑ 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
Bio`_
❑ NA
❑ NE
other than from a discharge?
12/2$/04
Continued

Facility Number: 82 -37 `] Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �EfNo El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes lJ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Designed Freeboard (in):
El NE
Observed Freeboard (in):(p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
2<o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed El Yes
,�,�
13"No
❑ NA ❑ NE
through a waste management or closure plan?
210 ❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
E Ngo
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P No
[--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
B<o
[1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
[:INA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10%ori 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ��-Via ala _�f 4 ) ��iL� �Prx�'N to . 5 .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[INA
El NE
15. Does the receiving crop and/or land application site need improvement?
ElB Yes
,M
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ngo [INA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
210 ❑ NA
❑ NE
1$. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comdtents (refer to gpestion ##): Explain any YES answers and7iir any recommendations or• any other comments.
-Use drawings of facil!6} to better explain situations. (use addtt> aI a esus necessary):
:a P P -g: ry}: - -
Reviewer/inspector Name F- 6 i G l�pY{�S Phone: (//O, $133,3300
Reviewer/Inspector Signature: Date: 1-22-2010
12128104 Continued

w
Facility Number: —377 Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q< ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes B o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,[�'�] N�o [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? E] Yes L o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ETN' ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo ❑ 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
B No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D'1vo ❑ NA
❑ NE
12/28/04

l3sacus /p —a7 — z o0 9
ivision of Water Quality
Facility Number $2 3 % 7 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit CrC�ornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Z.1: D((Departure Time: �Z ; �d County: SGI±EW JIM/
Farm Name: A -b , ice
t1 t'SW�+ Owner Email:
AOwner Name: I kms, rNG : Phone:
Mailing Address:
Physical Address:
Region:
s
Facility Contact: S r`, r'W < r4 Title: T FfC : Phone No:
ar
Onsite Representative: JTZ -w Liar cn/ g Cu,- s ]r7rr�/�i integrator: C�o � a y C.- / U 041.'tS
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: latitude: [� o ❑' ❑ u Longitude: ❑ ° ❑ ' ❑
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
❑
Layer
00 1'7&81 1❑Non-La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current,
Cattle Capacity.: Pokiflon!'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 'L(' No ❑ NA ❑ NE
❑ Yes
❑ No
ETN' A.
❑ NE
El Yes
E] No
0NA
❑ NE
❑ Yes
❑ No
L'] NA
ElNE
❑ Yes
PTNNo
❑ NA
❑ NE
❑ Yes
[! No
❑ NA
❑ NE
12/28/04 Continued

Facility N umber:62-377 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,[B Ngo ❑ NA [__1 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ 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
EJ<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
,�/
[3 o ❑ 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? ElL7
Yes
NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes
ElL'J
,No
'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 El9 Yes
/
o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes
DNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0610 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ f=ailure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) -':?t.�wv
13. Soil type(s) o-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes dNo
dNo ❑ NA ElNE
17. Does the facility lack adequate acreage for land application? ElYes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes D No ❑ NA ❑ NE
Reviewer/Inspector lame F -9i C -KL S Phone: y/0, J 33 -333
Reviewer/Inspector Signature: i,-� Date: 9' fs_ 2dD g
Page 2 of 3 12128104 Condnued

Facility Number: 82 37 Date of Inspection
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Cj 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
Z Ngo
[INA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
D"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E o
[:1 NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[]"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ON.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
<oo
El NA
[:1 NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
ElL7
,[._
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
& o
❑ 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
[IE Yes
�,/
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
2M/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

a1 ,us e/29/o S A!X-
Type of Visit OTompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: $ `12-40 S Arrival Time: %� sD,g4.t Departure Time: %Z:ZY County: �.*cQSv.�/ Region:
Farm Name: _ ADS_ay:.5s �i Z Owner Email:
Owner Name APT ra v -- T_4,FL- Phone:
Mailing Address:
Physical Address:
Facility Contact: C UO -1r.5 Title: 7 C-4 • Phone No:
Onsite Representative: 6i 147'_s Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� 4 F --I 44 Longitude: [= o [� t =
64
Swine
❑ Wean to Finish
Design Current
Capacity Pap la 'on
❑ Layer
Design Current Design Current
JPulation" CSttle Capacity Population
❑ Dairy Cow
® Wean to Feeder
I100
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
[3]A
❑ Dairy Heifer
❑ Farrow to Wean
❑ No
Dry Poultry
�~ ❑ Da Cow
❑ Farrow to Feeder
❑ NE
❑ Layers
= ElNon-Dairy
El Farrow to Finish
❑ NE
❑ Non -Layers
❑ Beef Stacker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
t 'i' '
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (I f 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 B No ❑ NA ❑ NE
❑ Yes
❑ No
O N A
❑ NE
❑ Yes
❑ No
gigA
❑ NE
[3]A
❑ NE
❑ Yes
❑ No
❑ Yes
❑<o
❑ NA
❑ NE
❑ Yes
❑<o
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: S2 —377
Date of Inspection F6 -iz-0$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): to
❑ Yes Q No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ETN' o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
6. Are there structures on-site which are not properly addressed and/or managed
[:1!� Yes
��
nro
❑ NA
❑ NE
through a waste management or closure plan?
Soil type(s) 1&t L $
14.
Do the receiving crops differ from those designated in the CAWMP? El Yes
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
e -No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0-56—
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�LT,1vo❑
L-55-- ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElE Yes
El'No
❑ NA
❑ NE
maintenance/improvement'?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
G-I'qo— ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Croptype(s)
13.
Soil type(s) 1&t L $
14.
Do the receiving crops differ from those designated in the CAWMP? El Yes
//
B"N* o ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
oo [__1,[ NA E] NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Ngo [:1 NA El NE
17.
Does the facility lack adequate acreage for land application? [j Yes
,E
NA El NE
18.
Is there a lack of properly operating waste application equipment? El Yes
�LT,1vo❑
L-55-- ❑ NA ❑ NE
Comments (refer to question 9). 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):
L
er/Inspector Name lTL Re—. V -.1 Phone: 91O, 5 33 , 3.3.3er/Inspector Signature: u.�c.h Date: -1Z ' Z 000
12/28/04 Continued

Facility Number: S2 —,37Date 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 appropirate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑ Qther
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 E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L[9 Noo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,LIQ N//o ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes L3No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 2<o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes B No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E JIN"o ❑ NA ❑ NE
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?
❑ YesdNo
I<No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
I<No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes EYNo ❑ NA ❑ NE
❑ Yes LTNo ❑ NA ❑ NE
❑ Yes 0 ❑ NA EINE
❑ Yes 0<10 ❑ NA ❑ NE
Add;it-ionidl.Comments;and/6r Drawutgs: `.
A.
7
Page 3 of 3 12/28104

E.vfe✓e d 4- 2 d- O I RR_
8 Division of Water Quality
Facility Number $ Z 3 O Division of Soil and Water Conservation
- O Other Agency
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine 0 Complaint O Follow up O Referral o Emergency Q Other ❑ Denied Access
Date of Visit: 'Z7 0-7 Arrival Time: Departure Time: z; ff County: OAJ Region:
Farm Name: �T—/� /+[ 'Ir t iKe., Owner Email:
Owner Name: kja r eAl Phone:
Mailing Address:
Physical Address:
Facility Contact: C1124S .S Rzle Jt , k Title: Phone No:
Onsite Representative: f!c�+--�t`S �4rtJtc �C Integrator: CD�i� ✓� <'q j'A'.S
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e =I
❑ Longitude: =0=' ❑"
S"rine
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
7771-7 ❑ Layer
!VLOO J�7� %� JE1 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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 . C
Cattle Capacity..Poj
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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
10 No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
qNo
❑ Yes
`P No
❑ NA
❑ NE
❑ Yes
A?No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: ff7 —3 ] 7
Date of Inspection Z -4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %
❑ Yes 0 No
❑ Yes [7No
Structure 5
El NA EINE
[I NA C1 NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?[INA El NE
(ie/ large trees, severe erosion, seepage, etc.) ❑Yes � No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes g2 No ElNA [:1NE
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 FIM No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 121 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 [M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [A No ❑ NA ❑ NE
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [,A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drin ❑ Application Outside of Area
12. Crop type(s) S a -dal— tie
13. Soil type(s) 4/a,;?
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [INo ❑ 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 W No ❑ NA [:INE
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
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 ;lc kL, tel/ S Phone: 33J
Reviewer/Inspector Signature: Date: 9 -z7 -Zoo
12/28/04 Continued

Facility /Number: Z --37-71 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �j No Cl NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
"No
90
❑ 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
�0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Dfl No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1�1 No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Division of Water Quality
=1=m=ber Z_ 3 7 7� 0 Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason €or Visit O Routine O Complaint O Follow up O Re€erral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3: I S r. Departure Time: . SO County: 5a.w P So Al
Farm Name: �Al A .3 Nu r -Se Z Owner Email:
Owner Name: /`r a r KA. S P4 Phone:
Mailing Address: !v G SnSs �G T Roy a�j a vo A/C. z g3 gZ
Region: AZOV
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=d
= Longitude: =o=,
o0, = «
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? (I!'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 1 of 3
Ll Yes 59No 0 N EINE
❑ Yes
Design Current
Design . Current
Design Current
Swine
Capacity Population Wet.Poultry
Capacity Population
Cattle Capacity Papulation
❑ Wean to Finish
❑ Layer
❑ NA
❑ Dairy Cow
❑ Wean to Feeder
1
10 Non -Layer
I
I
❑ Dairy Calf
® Feeder to Finish
O
Dai Heifer
❑ Farrow to Wean
ry Pory"
I
.Cw',
:..Farrow
❑ Cow
to Feeder
�'"
ElLayers
❑ Non -Dairy
❑ Farrow to Finish❑
Beef Stocker
❑ Gilts
r ❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Co
❑ Turke sz
❑ Turkey Poultsi
Ir
❑ Other
❑ Other
Numlie�ofStructures:
- •� n
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? (I!'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 1 of 3
Ll Yes 59No 0 N EINE
❑ Yes
® No
❑ NA
EINE
❑ Yes
[A No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[�M No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: $Z -377 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): 37
❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
M No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
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?
17. Does the facility lack adequate acreage for land application?
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
[:1 No ❑ NA V] NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA [3 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA J9 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA ® NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) Se. rnot +ti d 4 � 5jrt c t 1 6:ea/�wi 60V 2d
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
N 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
[�2 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[A NE
'Comments (refer to question #): Explain ariyIYE&answers and/or any recommendations a;any
other coninients 1aJse drawings of facility to better explainsituations (useadditional pages as necessary.): a
FOC l �. i y i S /.'S% d r: S �:i wJ 4.J d �:• r NX Cf : ✓z s s T1.. s i ry �I�: � %�:.,/ ire �ltc4l e� 44--4- A10 A166
lo/�+-cSz..1�-td�'.vs1s 1�.a.rt be /..i de44rcyd . F_%1, .. t,s .j r, i' br-.t-A/
lave, cva�l6.J Y SQvw: 4t�IrS Ikv- aesr rn/[frc_.IZCi 'Xtc7 !-�i�,-s.a wa6 --.cwt() yo /j
4e. r, jr---p �{ �wiUc-�/�V� Nom.. Lx -J e..v 4'r'r�elb� /t..ra%3 Batw-'Cdt/
4�} ee .w,] GlJ ��VS l��d ?41�..,. ftel t�0e� [.NiC GT" t��-..f hl �.YSGIp�C. CC G.:
Reviewer/Inspector Name �y� ,�c iC iZ �l'Z E S ; V- - ----J-�--� Phone: (1l0) Y33-3300
Reviewer/Inspector Signature: Date: -7'31 y 2-40(a
Page 2 of 3 12/28/04 Continued

Facility Number: $Z —37'] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ® NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 19 NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA Z 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
❑ No
❑ NA
CZ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ No
❑ NA
0 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
® NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Co NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
WNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
[R 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
[M 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
[9 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
® NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
ERNE
d
%1diteonal Coriiments and/or Drawings '
•
•
'�� w
12/28/04