820395_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

�s
Diiris`iom of Water Resources
Facility Number ®- 3gS Division of Soil and Water Conservation
Q Other Agency
Type of Visit:Com�pliance Inspection =Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: f•./ `� Arrival Time: c?O Departure Time: { bt7 1 County:
Farm Name: Ghd�r C��,� ; J s7v Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: s�,g7� . f�1�7` � Title: e,�9-Avr7 -r-1- Phone:
Onsite Representative: �_ Integrator: ;
Certified Operator: ..t�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: )E:��O
Swine
Design Current
Capacip:
-
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
on -Layer
airy Calf
Feeder to Finish
` `"
-
D . P,oul
Design
Ca aci
Current
Po
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
—.Non
Pullets
Beef Brood Cow
_:
Qther
ts..
f" .0 ..
Turke s
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes [] No
[:]Yes ❑No
❑ Yes E3'lq-o
❑ Yes ❑'Igo
[]NA ❑N
❑ NA ❑ NE
❑NA ❑N
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - SDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):oil
/ �r
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?
Structure 5
No [] NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No [] NA ❑ NE
[:]Yes [�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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ]o 0 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes El -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EjNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]0% or 10 ]bs_ ❑ 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): NW / �47.g 11VIA4T
14. Do the receiving crops differ from those designated in the CAWMP? _ ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E]'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
ffN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[J No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have
NE
the to the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'leo
❑ 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 [fj 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 C3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C 'No ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Facili Number: [Date ofinspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
0 N ONE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
[f"No
[a NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
[E] No
❑ NA
❑ NE
❑ Yes
[]"No
❑ Yes
E3 --No
❑ Yes
]o
E] NA []NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: _5�4-rf Phone:/l� SCS--�!•s(
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

it
Type of Visit: -Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Wlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' 14-1 County: pL Region: '
Farm Name: �/1�.��L13- 411 Owner Email:
Owner Name: C %i%; s Phone:
Mailing Address:
Physical Address:
Facility Contact: _5_e�6-� lea -,A& __jr, Title: 7 r.r' Phone:
Onsite Representative:
Certified Operator: r
Integrator: Y a --r
Certification Number: /%g��
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: 0 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?
❑ Yes UNo ❑ NA ❑ NE
❑Yes
E:] No
F-1 NA
Current
Design Current
Design Current
SwDesign
me �Capactty^Pa� WetaPaultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish La er
Dai Cow
Wean to Feeder Non -La—
Dai Calf
Feeder to Finish -50D
""f"l
Dai Heifer
Farrow to Wean "° Desegn Current
Dry Cow
Farrow to Feeder-. -Drys Pou!
Ca aci P,o .
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts * Non -La ers
r:q
Beef Feeder
4 Boars `. Pullets
Beef Brood Cow
R�Rt Turkeys
A}*�
* 3 Other, , Xl-Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 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?
❑ Yes UNo ❑ NA ❑ NE
❑Yes
E:] No
F-1 NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes D3 -No
❑ Yes ,ZI—No
❑ NA ❑ NE
❑NA 0 N
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of—inspection:
E No
❑ NA
Waste Collection & Treatment
❑ Yes
1E 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 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
9ObseDesigned Freeboard (in): /9-
Observed
rved Freeboard (in): 31, . 7� �(_ -
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 [VI 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 Jallo ❑ 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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes La No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ®.No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
1E No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes RNo ❑ NA [[] NE
❑ Yes 0 No' ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
DWUP ❑Checklists [:]Design ❑Maps❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 54 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [—]Crop Yield [❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: —70
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes BZ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ gNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [B -No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [. No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [�JNo
❑ Yes E -No
❑ Yes 2 -No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional oases as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:��
Date: 2f_____7b
21412015

0
i ype of visit: �' � ompi�ce inspection V uperation xeview V structure Evalustion V tecnnicat Assistance
Reason for Visit: C�7. Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:[=County: Region:
Farm Name: �/7�X S p % �� y�� S Zi A Owner Email:
Owner Name: SG,y fyl�f�; s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: 4 - '-t Phone:
Onsite Representative: Integrator: &lr��y
J
Certified Operator: Certification Number: /�f!S"g
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)
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 D4.No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ®,No
❑Yes U No
❑NA 0 N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412015 Continued

Facility Number: - Date of Ins ection: /
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3 g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!g -No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2�No
0 NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ 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
g No
❑ NA
❑ NE
maintenance or improvement?
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L3 -No ❑ NA ONE
❑ 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): 4f/ % ;4( / e[zlear*��Y
13. Soil Type(s): n
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 gg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2 -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 RNo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q 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 2/4/2015 Continued

Facility Number: - Date of Inspection: — G,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
R
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C�J_No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question #): Explain any YES answers and/or any additional
Use drawings of facility to better explain situations (ase additional pages as nece!
Reviewer/Inspector Name:
�•�� (�-z'c jfi�--ter
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑N
❑NA ❑NE
[:]Yes allo D NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [a No
❑ Yes ® No
❑ Yes ® No
ons or any other
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
comments.
Phone:
7
Reviewer/inspector Signature: Date:
Page 3 of 3 21412015

la rls
qS
(Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0-1toutine 0 Complaint 0 Follow-up 0 Referral 0 Emer2encv 0 Other 0 Denied Access
Date of Visit: Arrival Time: p i3 Departure Time: p County:. S
Farm Name: -h Owner Email:
Owner Name: -� �Q�S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �d L� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: FRO
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 (2 No ❑ NA C] NE
of the State other than from a discharge?
Page l of 3 2/4/2014 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
WetPoultry
Capacity
Pop..
Cattle Capacity P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish 20 215
DairyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder D Poul . C ap ai Pzo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turke 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 (2 No ❑ NA C] NE
of the State other than from a discharge?
Page l of 3 2/4/2014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a, if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in):� i
5. Are there any immediate threats to the integrity of any of the structures observed'?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes allo ❑ NA ❑ NE
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
S 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
Ca No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E?,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any pari of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®.No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
C�
12. Crop Type(s)-. n �J t / LfJy� �S 6Y -,s / /t/i 4_ fs� / lh�" /,*- k)
13_ Soil Type(s): _ ' y l ffD- / gja-,T _
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes Eg-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [3No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D3.No
❑ NA
LINE
18. is there a lack of properly operating waste application equipment`?
❑ Yes
S No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ES.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP 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 ER 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 E[No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facifi Number: - j Date of [ns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ®No ❑ NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5�_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 MNo ❑ 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 the drains exist at the facility'? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes gLNo ❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
❑ Yes CNo
❑ Yes CR No
❑ Yes �jNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: ��r-y% ��y��j--- Phone: z
Reviewer/inspector Signature: Date:
Page 3 of 3 2/4/2011

sli G - /7- -1 O -J Lf
Type of Visit: ompliance Inspection Z5 Operation Review 0 Structure Evaluation 0 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: ; V O County: ��tr�Jsf!-�• Region:
Farm Name: C�`j�S� epl`i`✓C.,/Oe C Owner Email: "7'�—
Owner Name:SG /y7p �,� Phone:
Mailing Address:
Physical Address:
Facility Contact: '5'Co.�_ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Disebarees 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 I of 3
❑ Yes 5ilNo ❑ NA ❑ NE
[—]Yes
[:]No
0 NA
❑ NE
❑ Yes
❑ No
❑ NA
Design Current
❑ Yes
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
I JLayer
I
Dairy Cow
can to Feeder
I INon-Laer
I
Dairy Calf
Feeder to Finish
k1 3,662
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P,oill
@iiaci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
F
Turke s
Other
Turkey Poults
Other
Other
Disebarees 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 I of 3
❑ Yes 5ilNo ❑ NA ❑ NE
[—]Yes
[:]No
0 NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[&No
❑ NA
❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
2/4/2014 Continued

liacili Number: - Date of inspection.
3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ 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): 2-
Observed Freeboard (in): �3 2- 3
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
2S 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
3kNo
❑ 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 ®-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 E] Application Outside of Approved Area
12. Crop Type(s): a xU It 1GUh r,s�/� � !/" /I 1 111'0s111Z le.- _;1__:5 -{ e-/
13. Soil Type(s): 4,rd 1.5off f L!%Q O
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 [A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Lo 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?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA C] 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 Lj§,No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No El NA El NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 19 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: -� ,3 --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LR No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [Z No
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes Co No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA [:]NE
❑ Yes JoNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
[] NE
[:]Yes
[5LNo
❑ NA
❑ NE
[:]Yes
VLNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: _4,23 _'pq 9/q
2/4/2014

Type of Visit: ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (7 Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ;$=/3 Arrival Time: Departure Time: /f' County._5, �Vz--- Region:
1011
Farm Name: ��,� Owner Email: �
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: s1%yJ �'3 Title: dyf&n Phone:
Onsite Representative: �� Integrator:
Certified Operator: J� Certification Number: �r18'S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dischar gs 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 allo ❑ NA ❑ NE
❑ Yes ❑ No
[] Yes [] No
❑ Yes [] No
❑ Yes ;&No
❑ Yes CS -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:INA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facility Number: � jDate of Inspection:
--�
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
Lr No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 2-
Observed Freeboard (in): .3 9_�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
'ELNo
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[$ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 l0 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): 4!5,9.-,v7 1N/W�•,,.�—�,$pyljra�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
�j�
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
I9. 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
_R No
❑ NA
❑ NE
❑ Yes
U3 -No
❑ NA
❑ NE
❑ Yes
Lr No
❑ NA
E] NE
❑ Yes .® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E�_No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑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 p 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 EK 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
0 N ❑N
Page 2 of 3 21412011 Continued
n

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 0 Yes [3 No 0 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 V] No ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 No ❑ NA ❑ NE
Other Issues
2$_ 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
® 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
0 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
[g No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g/D _ 1.33-330
Date: AF
2/4/2011

of Visit: (Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:C Departure Time: ! County: Region
Farm Name:�rs4 2 ��r-1� Owner Email:
Owner Name: S'�i4- /%%;S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Ste_
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: I',`
Certification Number: / 7 g��9
Certification Number:
Longitude:
Degn .Curren#
':
Design
Current
Design Current
Swtne ,�Capactty Pop.
Wet Poultry
Capacity
P,op.
Battle Capacity Pap.
Wean to Finish
Layer
Cow
Wean to Feeder
Non -Layer
—Dairy
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Douh
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
113eef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impart
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 �No ❑ NA ❑ NL
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes []No
❑ Yes Ca No
0 Yes M No
❑ NA ❑ NE
❑ NA ❑ NL
❑ NA ❑ NE
0 N ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
!� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ![ No ❑ NA ❑ NE
(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 F1 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [g No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops dif7er from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &. Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
t4 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes f,:;a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C& No
23. 1 f selected, did the facility fail to instal I and maintain rainbreakers on irrigation equipment? ❑ Yes Rj No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: I Date of Inspection: 7 /,,;? --
,i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes. check the appropriate box below.
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[DNA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �Z No ❑ NA 0 NE
❑ Yes ® No
[:]Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/]nspector Name:
Reviewer/lnspector Signature:
Page 3 of 3
Phone:frJ
Date:
2/4/2011

Division of Water Quality G
Facility Number 1 99 015— 0 Division of Soil and Water Conservation ,
i Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine Q Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name__� F.`y &�'/o -' Owner Email:
Owner Name: _A� G'�r f}1� j Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: �.
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title: Oen � Phone:
Integrator:
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Laver
Non -Layer
Design Current
Dry Poultry Conacity Pon.
Layers
Non -Layers
Pullets
Turkevs
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle =C
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes FNo [:]NA E] NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes J;�_No
El Yes �,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

[Facility Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9CNo ❑ 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
KNo
ldcntifier:
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
[5No
❑ NA
Designed Freeboard (in):
the appropriate box.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
al No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
21. Does record keeping need improvement? If yes, check the appropriate box below.
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes
F71 No ❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis
❑ Waste Transfers
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
J� No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes
ZNo ❑ NA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
KNo
❑ NA
9. Does any pari 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 C] NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes
No ❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift Application Outside of Approved
Area
//Window
/❑
12. Crop Type(s): 1��`e� /�T/fr-s��-�fJ/Yl_ /�G�i
13. Soil Type(s): _ ! 0 B: -/ Z& ,_e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5� No ❑ NA ❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesNo ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 14No ❑ NA ❑ NE
[:]Yes 3,No ❑ NA ❑ NE
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
[5No
❑ 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
JQ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfali ❑ 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
[RNo
❑ NA
[] NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ES -No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes La No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes
2 ,No
❑ NA
❑ NE
❑ Yes
KNo
E]NA
[DNE
[:]Yes
�No
[:]NA
E] NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:f%
Date:
2/4/2071

I'.
type of Visit ('Compliance Inspection U 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: t7 t7 Departure 'Time: fl County:
Farm Name: �� d✓ / Owner Email:
Owner Name: f- SG Phone:
Mailing Address:
Region: J92�1)
Physical Address: y� �
Facility Contact: /f'I 7�i� Title: 6OW17 r✓ Phone No:
Onsite Representative: �jC�.�� Integrator:
Certified Operator: Ste— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =, =u Longitude: =o E -1-1I = u
Design0Nffrrent
Design Gurrent
urrent
011wC
50aatoirlidon
pulation
Wet Poultry Capacity Population
C►attle
❑ an to Finish I I❑
La crI
I❑Dai
Cow
❑Wean to Feeder
❑Non -La er
t I
Dairy Calf
eederto Finish
_
Dairy Heifer
❑ Farrow to Wean
Dry Poiwltry
❑ Dry Cow
❑ Farrow to Feeder
®-No
El
Farrow to Finish
❑ La crs
LaEl
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page I of 3
❑ Yes O.No ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9,No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: j Date of InspectionS—/
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): _ / c} /7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C3 -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [9No ❑ NA ❑ NE
❑ Yes JR 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 X 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 B No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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) ! z2 a it1i1 X„ —_....... ,...
-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
J9.No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
JR 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
;110
❑ 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 }
Reviewer/Inspector Signature:
Page 2 of 3
Phone: —/,9 L/33 -3 3 0
y
Date:�'=S �I] f a
12/28/04 Continued

Facility Number: — Date of Inspection
rt Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 Kilo ❑ 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
allo
❑ 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
tZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
[INA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[a -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
allo
❑ 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
E -No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E2 -No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit &aompliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
�outine O Complaint
O Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date of Visit:���—_� Arrivall Time: ,1(DDeparture Time: � County: Region:
Farm Name: - �(x,1 tis 7 -, ;L pal -)0 Owner Email:
9'
Owner Name: =S'G &IT- &Z Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S�
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ,�%r510G
AV
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=0
01 =11 Longitude: =0=c
n=c 0 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �g No [--INA ❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
Design Current
Design urrent
I
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
LA
❑ Boars
❑ Wean to Finish
❑ Yes
E01Laver
El Dairy Cow
❑ NE
❑ Wean to Feeder
❑ Non -Layer
El Dai Calf
Feeder to Finish 1q3qQ
3 (p
d. Does discharge bypass the waste management system? (If yes- notify DWQ)
El Dairy Heifer
❑ Farrow to Wean
❑ NA
Dry Poultry
ElD Cow
El Farrow to Feeder
allo
❑ NA
ElNon-Dairy
El Farrow to Finish
[:]Yes
❑ Layers ers
El Beef Stocker
Gilts
other than from a discharge?
ElNon-Layers
❑ Beef Feeder
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑Other
❑ TurkeyPoints
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �g No [--INA ❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ NA
❑ Boars
b. Did the discharge reach waters of the State'? (1 f yes, notify DWQ)
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �g No [--INA ❑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'? (1 f 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
allo
❑ NA
❑ NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
[9No
❑ NA
[:INE
other than from a discharge?
12128/04 Continued

Facility Number: —3cj► Date of Inspection 9�a
❑ Yes
❑ No
'A'aste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�RNo ❑ NA ❑ NE
a, if ves, is waste level into the structural freeboard?
El Yes
❑ No ❑ NA ❑ NE
Structure I Stnicture 2 Structure 3 Structure -1
Structure
1; Slructurc G
Identifier:
❑ Yes
❑ No
Spillway?.
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
❑ No
❑ NA
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[K No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
5d 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
29 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑I Yes
9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
1
9. Does any part of the waste management system other than the waste structures require
❑ Yes
N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
® No ❑ NA ❑ NE
maintenanceJitnprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9No ❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
i ❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 9L/6--,y-s-5—j3
Reviewer/Inspector Signature: Date:
12128/04 Continued

f Facility Number: .7341Date of Inspection ®9
Iteguired 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 [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP [] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LR 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
RjNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
PSNo
❑ 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
2 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
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Comments and/or
12/28/04

Type of Visit compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit (?J' outine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �r--_�%� Arris al Time: Departure Time: 3 0 County: %° --! Region:d
Farm Name: __ f J, '5'1 Qi��G�i�'_ Owner Email:
�1'S
Owner Name: G�-! / f� /S Phone:
Mailing Address:
Physical Address:
Facility Contact: --SG Title:
Onsite Representative:
Certified Operator:-•�_..
Back-up Operator:
Location of Farm:
Design Current
Sw me Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification lumber:
Back-up Certification Number:
Latitude: =' ='
="
Longitude: = ° =
Design Current
Wet Poultry Capacity Population
❑
Layer
❑ Non -Layer
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Puilets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current -�
Cattle Capacity Pou19"
❑ Daia Cow r=
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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?
Page 1 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
JR No
❑ Yes
54 No
❑ NA
❑ NE
[--]Yes
[R No
❑ NA
[:INE
12/28/04 Continued

Facility Number: — Date of Inspection
= Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5No ❑ NA EINE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [:INA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /� 1
Observed Freeboard (in): —37
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.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
® No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
V) No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
❑ No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
5d No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[$ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (referlo.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):
AL
Reviewer/inspector Name t/ Phone: -0
Reviewer/inspector Signature: Date:
Page 2 of 3 12/28/04 Conhnued

23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
t Facility Number: 3 14 Date of Inspection �tr
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Z No
i
Required Records & Documents
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes
[gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes
(ONo
[INA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes
15No
❑ 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
E9 -No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[1 No
❑ NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
EINE
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
(3 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
[9No
❑ 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
NNo
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/ Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
( No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

sion of Water Quality -- ;—de
Facility NumbermEjj 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompHance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visitoutine
0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Lizelid� Departure Time: % County Region:
Farm Name: /� 1` /— Owner Email:
Owner Name: �� ��, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: if,2zZenom
Operator Certification Number: zz!z
Back-up Certification Number:
Latitude: = = ❑ 6 Longitude: =0=, o=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
T— �_, ❑ Non -Laver
Dry Poultry
❑ La crs
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge ohsen^ed from any pan of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures -
b. Did the discharge reach waters ofthc State? (If yes, notify DWQ)
e, 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 CKNo ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
12/28/04 Continued

.t Facility Number: — Date of Inspection T—AP7
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): f 9
Observed Freeboard (in): q,3 �S
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C9No ❑ NA ❑ NE
❑ Yes allo ❑ 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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P 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 gNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CgNo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes Flo ❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[R 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
EINE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rONo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
69,
T
Reviewer/Inspector Name ✓ �ir� (T B z� Phone:
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: Date of Inspection_
r
Reuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes ONo [INA ❑NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes. check the appropriate box below. [%Yes ❑ No ❑ NA ❑ NE
42LWaste 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
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C.No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
r-Z;rNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[RNo
❑ 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
EffNo
❑ 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
RNo
❑ 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
CK No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
64 No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

1
eY'D-ivision of Water Quality.e
Facility Number S O Division of Soil and Water Conservations'
E
(� Other Agency V
0
Type of VisitComn�pliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
J2 outine O Complaint
O Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date of Visit: L 7 Arrival Time. /Departure Time: D(} County: Region: F D
le -
Farm Name: zi- . T lTi X cc r /, p/„ Owner Email:
tl
Owner Name �G Dom_ _ /%!ai S Phone:
Mailing Address:
Physical Address:
Facility Contact: - SC' G tr_ %�a 5 Title:
Onsite Representative: 5fGrrI�e_ _
Certified Operator:�—
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: &I m:^ _�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 P =I = Longitude: =0=,
°❑, ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I 1 ❑ Laver
❑ Wean to Feeder I 1 10 Non -Layer
Feeder to Finish 3 D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑
Turkeys
❑
Tu rkey Poults
❑ Other
Discharp_es & 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'?
Cattle
]
Dairy Cow
]
Dairy
] Dairy Heifer
]
Dry
]
Non -Dairy
] Beef Stocker
] Beef Feeder
] Beef Brood C
D k L
,
Number of Structures
b. Did the discharge reach waters of the State? (Ifyes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
Page 1 of 3
❑ Yes ❑ No ® NA ❑ NE
❑ Yes
❑ No
[N NA
❑ NE
❑ Yes
❑ No
2 NA
❑ NE
[K NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
RLNA
❑ NE
12/28/04 Continued

Faciliri� Number:
1
Date of Inspection 4p
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): _ 3c 3 `�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [X No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [3No ❑ NA ❑ NE
❑ Yes 29 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 [9 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 El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �4No [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes [3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �f%h s�// s�S� /
13. Soil type(s)--
r
F,r,� �ircts
Reviewer/Inspector Name°rt/ ( ,z� Phone: i
Reviewerllnspector Signature: Date:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4LNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
R No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[K.No
❑ NA
❑ NE
Comments (refer til question #): Explain any YES answers and/or any recommendatiois.or.any, other comiments.
Use drawings of facility to better explain situations. (.use additional pages as necessary:' ^; ,
F,r,� �ircts
Reviewer/Inspector Name°rt/ ( ,z� Phone: i
Reviewerllnspector Signature: Date:
12/28/04 Continued

J
Facility Number: — Date of Inspection �✓�'"fl
i
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes [ZNo ❑ NA EINE
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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'" No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'S No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®,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
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PRNo
❑ NA
❑ NE
1 f 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
Z 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
K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R_No
❑ NA
❑ NE
Additional &m ments and/6i Drawings:
12/28/04

m �r•
W Divtshm of Water Quality, `k
FactL � Nnmber �
try. _ fjZ39,s 0 Division of Soil and Water;Conservatton ;y
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s�?SI J~ Arrival Time: $ :00d Departure Time: County: San.nsajJ Region:
Farm Name: _ hl� Pct- /o+' Owner Email:
Owner Name: A-7. Phone: 4C0
.Mailing Address: '5-040'9 _ - %'YIn_S _Jay %>l V t.� _ C 1:si14 v," /V C A S19 D g
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 5C-.* -+ PNo- -0,; � - Integrator: Pr Gs +.-!7 �
Certified Operator: Operator Certification Number: �7,?S9
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1 =11 Longitude: = o ❑ i =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La ycr
❑ Wean to Feeder 10Non-Laver
® Feeder to Finish I Z1310 3-2¢a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -[-avers
❑ Pullets
❑ Turkevs
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge obsen•ed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made''
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dain° Calf
❑
Dairy heifer
❑ Drz Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: o
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is tate estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste mana4,rement 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 EX No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑Yes
�]No
El NA
EINE
12/28/04 Continued

c ,
Facility Number: — S
Date of Inspection ss�
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?
❑ Yes W No
❑ Yes ❑ No
❑ NA ❑ NE
El NA [I NE
Structure 1 Structure 2. Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 " .-
Spillway?: -- k/07110 Na -P t.-. trecoI'As .
Designed Freeboard (in): 07 Al N'
Observed Freeboard (in): #0 .40
5. Are there any immediate threats to the integrity of any of the structures observed? [--]Yes 14No ❑ 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? ❑ Yes Q9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [X 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 [A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA El NE
❑ Excessive Ponding Ell-lydraulic 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. Croptype(s) __i_
13. Soil type(s) PZ9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
99 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
FA No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any, YES answers°arid/oriany•recommendations or any other comments: -
x
Use'drawiings of facility to better explain situatians�. (use,additioaalaQages as -necessary): }
� � �a►.1l` i s �vc� r,�
G i, a w I -e- .+e +o WX,0- 1 �- e_ -t" 1s 4 G L4 V' Y -w- U_r6 -Y -' +^^-
IRe-*2ewerl[nspector Name - - —-- Phone: I
Reviewer/Inspector Signature: ,��� Date- /-�s/Q-r
12128104 Continued

r
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (A No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [M 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
W 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
CM No
❑ NA
EINE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W 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
N] NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JK] 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
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
%I No
[:1 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
R] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additioinal'Comments andlor Diawiings:
12/28/04
._

r
- -ry- -r � �. � �� r} •�Y15iQn�of W$teryLaaaal`J�.u�. '�' � �-s-_.��r� � �`�� �' � f`y ''� ��-..,.°3sr.�-_
s• ,. � -z � .�,%'-� ' c -.r'" � �'D1V!$lOi,1 Of+��O� dna WatErsCOi1SCiiratZOIL - �-� -xr�� �".. "�`�-� :�.4 K n, x.., s '
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Bate of Visit: `f• �4-p Time: y� OD
� �
Q Not O erational Q Below Threshold
M -Permitted ©<e—rtified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ........ ��ia.f. ....... L.Uf ...... — - - - -- ... _ County:..._. S Q.,�s_un ....... ................ .... .
Owner Name•/� 5-cQ]� M 1`�r..s..... ....... -----........ Phone No: _.9.�..jD` �� 7 l �/5��._Q.....................
flailing Address:....._ .s O.P..2 ..... !.91e ' .ywe ...._.........._ C%i��t1'1 _} N� ._._._.__.._._�..�.s' �. a $......... ..- ....-----...
Facility Contact: .._....' c3 C!P. �1t .5.... ...... _............ Title: ........ Phone No: -5'- 9 a -�1 `/� f
Onsite Representative: ....... c off Mg ....... ........................................... Integrator:... .........__.._...
Certified Operator:._ -dA eP-;x.._.._........ ��1 ►.f._._ .................... Operator Certification Number: 12g.
Location of Farm:
E14w�ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 && Longitude • & "
Design Current
.ZYWAI C
Lj Wean to Feeder
er to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number ;of Lagoons
Design, Current
Poultry Ca .aci -POOillation
❑ Layer
❑ Non -Layer
10 Other
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current_.
Cattle Ca ari Po =atioif
❑ Dairy
❑ Non -Dairy
Total -Design Capacity
Total SSLW
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 ❑-Ko
❑ Yes G -1'4o
❑ Yes [�o
❑ Yes E; -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [}N✓o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0>6
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ----- .......
Freeboard (inches): ql ",
12112103 Continued

1 Facility Number. gZ —3 q
Date of Inspection X1-3
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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A polication
10. Are there any buffers that need maintenance/improvement?
I1. is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
CGtaze,)
12. Crop type Co.,, . S /_„ _ 6vA__ <. C.__..., Li.-_ /__ ,4_ _. . . /� . T,, 4, _ _
inn is
13. Do the receiving crops differ with those designated in the. Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
I Wo
❑ Yes
E-bic -
❑ Yes
❑'10
❑ Yes
['N ek-
❑ Yes
LLNo
❑ Yes
.911110
❑ Yes
❑ Yes O-NiS
❑ Yes BITo
❑ Yes 9 -Ko
❑ Yes ,[�5
❑ Yes Iry o
❑ Yes ERitf
❑ Yes ❑ No
❑ Yes ❑-Ko
❑ Yes ❑ No
❑ Yes BNO
COmmentS ref 4
( er to question #) Explain any YES a�wers i a or any. recommendations ar ppyµother oommenty.
Use drawings of f Hfi to'better Iain s}tua#ro�. ase addttsanal es as necessa µ W_- wr ..
L . ty exp, E p' ry):'-- [+ WwMd Copy ❑ Final Notes
Reviewer/Inspector Name Ala rli (f rk � orf Bin -
Reviewer/Inspector Signature: Q Date: Y-1 '1- v
12112103 Continued

Facility Number: _ 9 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1zTP,-chec is esign, m etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Applicatiorr-O Freeboard ❑ Waste Analysis'❑ Soil Sampling-'
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need imp�ro �ment? If yes, check the appropriate box below
❑ Stocking ForttT--o Crop Yield Form ❑ Rainfdtl ❑ Inspection After 1" RahT-�
Z;(
❑ 120 Minute Inspections—flAnnual Certification Fornt-�
❑ Yes B -M
❑ Yes �
❑ Yes ©-No
❑ Yes ❑-No
❑ Yes
❑ Yes E].No
❑ Yes ❑-No
❑ Yes U -N -o
❑ Yes U.Nia
Effe's ❑ No
❑ Yes 9 -No
❑ Yes [� its✓
❑ Yes [moo
❑ Yes GINo
❑ Yes 9-NIO
13 No violations or deficiencies were noted during this visit. You will
receive no further correspondence about this visit.
Additional: Comments and/or. Drawings
-
.�
._ � -. .� A r..
� 33 PSP�
s oye bus
&a.,e ��P
KM3
ks r7V s"
12112103