820398_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: g'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: O.` / r Departure Time: ,' �7� County:- Region:
Farm Name: rr-j-C T&P ta.,, F 0, Owner Email:
Owner Name: UQ/7?Phone:
Mailing Address:
Physical Address:
Facility Contact: al tol C Title:
Phone:
Onsite Representative: Integrator: yrs
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Ill esign- Current
Design
Curren#
EDesiMapacity
Pop.
Wet Poultry
Capacity
A yPop.
CattleOa civPap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
'X Feeder to Finish D'�
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D. P,oul
Ca aciY
P,o
Non -Dat
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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 [DNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ff"No
❑ Yes [3-1 o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
t� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�] I Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).-
Observed
in):Observed Freeboard (in): 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 D<O ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [:rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [],"�Io ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3No [DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ED -'Ko ❑ 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): tv'1 )c,-/ �s Yoh
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [! l<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2'1�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
t8. Is there a lack of properly operating waste application equipment?
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3--5o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes []'�lo ❑ 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 [3 N
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E' No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

FaciliNumber: - "i91911 jDate of Ins ection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej_Ko
,* 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'O
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 ETN.
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3 -74o
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 ❑N
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [E]No ❑ NA ❑ NE
❑ Yes L7 "1O ❑ NA ❑ NE
❑Yes E]No ❑NA E] NE
❑ Yes E --No ❑ NA ❑ NE
❑ Yes [D] No ❑ NA ❑ NE
❑ Yes Na ❑ NA ❑ NE
❑ 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 exDlain situations (use additional nacres as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: // 3
Date:`(9�1�
2/4/2015

i+
l'ype of Visit: cUCOUMILianCelDspectiOD V Operation Review C.3 Structure Evaluation U Technical Assistance
Reason for Visit: Routine OComplaint 0 Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: I-} Departure Time: County:_: u Region:
Farm Name: G �� �p�GC�s"�1_ Owner Email: T���
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 6/- -p-- At'Oyr'�_ Title:
Onsite Representative:
Certified Operator: /.4— rr�
Back-up Operator:
Location of Farm:
Latitude:
Phone -
Integrator:
Certification Number:
Certification Number:
Longitude:
E
Design
Current �E
❑ NA
Design
Cu'"treat
rti
1i�gn Current
` Swine
Ca act
Po r
Wet Poalt ry,
Capaerty
I��Pop.
❑ Yes
llI'
Cattle Ca act Po
P h' p•.
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
Wean to Finish.
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
La er
. F�Sj No
❑ NA
❑ NF
Dairy Cow
Wean to Feeder
O—No
❑ NA
Non -La er
of the State other than from a discharge?
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
1Jesign
Current
3,
Dry Cow
Farrow to Feeder
D ?Pgil
C act
PoP.
Non -Dairy
Farrow to Finish
I
Lavers
Beef Stocker
Gilts
I
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
p11 I
'!II is
,'.'
;
r
j lip
I'urke s
,
E:
Other
Turkey Poults
Other
10ther
101111
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
FNLNo
❑ NA
[_]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
. F�Sj No
❑ NA
❑ NF
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
O—No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2015 Continued

Facili Number: - jDate of Inspection:
—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ivo
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Lj4.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
1j'g No
❑ NA
❑ NE
waste management or closure pian?
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
LNo
❑ 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
J No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�jA10 ❑ 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): o/'.4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [jZNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If ves, check [:]Yes &No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, 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 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes fR No
❑ Yes CQ—No
❑ NA D NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: r
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 E4 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 j No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C3,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)
3 I. 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 allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes p No DNA ❑ NE
[—]Yes " No E] NA ❑ NE
❑ Yes No
❑ Yes [ No
❑ Yes allo
NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer; #o question #): Explain any' YES a s'we'siand/or anyadditioniil,recoRiireendations or any other comments. '
Use drawiggs'af facility to better explain sitnations..[us ii"ittonal pages as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:-��1-��
Date: `�� 7
2/412015

I
Type of Visit: E)compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; aLb County:
Farm Name: Fad Owner Email:
Owner Name: r �, , z ! ) e r y Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: /7%G/"i_ Title: / g"e— - Phone:
Ti
Onsite Representative: Integrator: �/zS
Certified Operator: t`\ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
DischariZes and Stream Impact
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
C3 No
❑ NA
❑ NE
Design Current
❑ Yes
Design
Current
Design Carrent
.iii. I1_ ...;
Swine
Capacity Pop.
Wet PoWtry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
t_.
—Non -Layer
Dai Calf
Feeder to Finish
SJ 1-37b
Dairy Heifer
Farrow to Wean
Design
Curreat
Dry Cow
Farrow to Feeder
D , P,anl
Ca aci
Po .
Non -Da
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L Beef Brood Cow
A-00
Turke s
Other
Turkey Poults
Other
Other
DischariZes and Stream Impact
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
C3 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

Faciti Number: - Date of Inspection: /6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &�_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Spillway?:
Required Records & Documents
❑ Outside of Acceptable Crop Window ❑ of Wind Drift
❑ Application Outside of Approved Area
Designed Freeboard (in):,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
R1 No
❑ NA
Observed Freeboard (in): 3_
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
13. Soil Type(s): �f
M -No
❑ NA
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.)
❑ Yes ® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes MNo
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
'�jj No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
j 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
Cg -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FM No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M -.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
Required Records & Documents
❑ Outside of Acceptable Crop Window ❑ of Wind Drift
❑ Application Outside of Approved Area
QEvidence
12. Crop Type(s): )� /,q uda_ 1f
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
R1 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
13. Soil Type(s): �f
M -No
❑ NA
❑ NE
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 ❑ Yes MNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
125 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
R1 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M -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 figNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking p Crop Yield [:]120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z3,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 -No
❑ NA ❑ NE
❑ Weather Code
CIS] udge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R[ No ❑ NA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [x] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EZ 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
fD 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
rV1 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
XNo
❑ 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?
❑ Yes4=9-No
F]NA
C]NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone--
Date:
hone:Date:
2/4/2014

,i
IType of Visit: aCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
�-
Arrival Time: UU
Departure Time: ; 3 O County: Region:r�a_`�
Farm Name:
ff�ar►"--
Owner Email:
Pop.
OwnerName:
Capacity
lj'/�r1`� `� Phone:
Mailing Address:
Phvsical Address:
Facility Contact: r� f rel /�/lDf1r-,r- Title: l Yah z'c- Phone:
Onsite Representative: �j'�•u� Integrator: �/ r-- c
Certified Operator: ' "'�� i -,—,r C 7 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
❑ NA
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
Non -Layer
Da Calf
,Feeder to Finishes
-
Da' Heifer
Farrow to Wean
Design
,Current
Dry Cow
Farrow to Feeder
iD , P,oult .
Ca aei
P,o
Non-DaiTy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.»,.
Turke s
Qther
-
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[W] NA
❑ NE
❑ Yes [:]No
❑ Yes ®,No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑NA E] NE
114/2014 Continued

Facili Number: - Date of Inspection.
❑ Yes
5a No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
1,—ANo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
5g No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
[D No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesLfl
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [LNo ❑ 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): 147� "�-
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes FLNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®No ❑ NA ❑ NE
acres determination? 7�
17. Does the facility lack adequate acreage for land application?
❑ Yes
5a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1,—ANo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
[�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P9-1�o
❑ 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.
El Yes _No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ci�No
Page 2 of 3
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facility Number: jDate 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 [3 -No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes �R 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
F] NA F] NE
❑ NA NE
❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewcrAnspector Signature:
Page 3 of 3
Phone: 91-P--'f33--33�0
Date:Jr-
214/20/4

Facility Number95117- imi J 9� MENDivision of soil and Water Conservation
O Other Agency
Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &RRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:I—Zy.a.l� Departure Time: :3U County: Region:
Farm Name: C ia5rerrt' Owner Email:
Owner Name: /�— erePhone:
Mailing Address:
Physical Address:
Facility Contact: �j fir' f-rr %Yipv Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:JIF
ti
Certification Number:
Certification Number:
Longitude:
-�,�°�-.-s' r � �-.4..r
Design Current `"" a DesignCdrrent _� Design Current
*_
Swine Capacity Pop ' VI'etX4ultry ' Capacity PoP # - =Cattle Capacity Pop.
Wean to Finish La er Dai Cow
Wean to Feeder � Non -La er Dai Calf
Feeder to Finish ` ` �^ '' e" Dai Heifer
Farrow to Wean _ Des n Currents D Cow
�4 ra i$
Farrow to Feeder d, Dry Poult�^,Ca ac�Po `""' -Dairy
Farrow to Finish Layers Beef Stocker
Gilts' Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
_ s _
Turke s
Other Turke Poults
:
Other 10ther
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)?
❑ Yes � No [:]NA [:]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: jg2Z Date of Inspection:
/
Waste Collection & Treatment
r 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 frceboard?
❑ 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
[54 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ 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
Lr -5 -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance 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): LsrsM" /A&! e" 'r�-� /lx)�/
13. Soil Type(s): yLr. r.. _
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 ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Z 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 E] 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 jo No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -I jDate of Inspection: s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ 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 p 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 E4No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
[:]Yes J0 No ❑ NA ❑ NE
❑ Yes (Q No ❑ NA ❑ NE
❑ Yes 14 No
❑ Yes ® No
❑ Yes [K No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3-33
Date:
21412011

Type of Visit: Q6-mp nce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: & outine O Complaint () Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: © Arrival Time: Departure Time: County: Region: (�
Farm Name: G (f G 1,9 /1001Fa le V%"*— Owner Email:
z 101'
Owner Name: ; ,tc i/ Phone:
Mailing Address:
Physical Address:
Facility Contact: K3 /rte/' AD -r V_ Title:
Onsite Representative: S v
Certified Operator: A` r?,,,`
Back-up Operator:
Phone:
Integrator: �/7 _7_
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑Yes �No
❑Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
-g
st n Current
Dp `"
nui rpent
y Design Current
Swine �f
Ca aci Po
ty p
Wet�PouEtryCap
W. 1�� Pte°
Capacity Pop.
,...aD�.'
Wean to Finish
La er
Dairy Cow
Wean to Feeder
ceder to Finish
Layer
airy Calf
Dairy Heifer
Farrow to Wean
Farrow to FeederDryPoulCa
Farrow to Finish
Gilts
Boars
iffit
- --
= Design Current
ciPo
Layers
Non -Layers
Pullets
Turkeys
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other -
Other
Turkey Poults
Other
may.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑Yes �No
❑Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5471 to
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 371D
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes 53,No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
RA -1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):lilt--
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes toNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 6A No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes to 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 [Z No ❑ NA ❑ NE
❑ Yes [c"' No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes §A No
❑ Waste Application p 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
E] NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M[No
[DNA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
(SNo
❑ 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
C, No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[S No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Co No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CKNo ❑ NA ❑ NE
❑ Yes [2No DNA ❑ NE
[:]Yes 5No [:]NA ❑ NE
❑ Yes Jallo
❑ Yes KNo
❑ Yes [)!I -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exoiain situations (use additional imees as necessarv).
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

type of vtsir: V Lompuance tnspeenon v uperanon mevtew V Ntrucrure r.vatuanon u iecumcal Assistance
Reason for Visit: EYicoutine Q Complaint O Fallow -up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: Q'
Departure Time:
County:
Farm Name: .,
_ �G Zaa � /i, -it -.
1
Owner Email:
Owner Name:
fT�r,,,,mi �/'G y
Phone:
La erjDairy
Cow
Mailing Address:
Physical Address:
Facility Contact: II /f�PD,�'j' Title: - ,ice . Phone:
Onsite Representative: 66n: / 1%&Pr integrator: �r
Certified Operator:; ,�; /C.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
'� � � '�w=k � � � *�°f7ke se•. .',� ..,_ :si-�E�}r.ia -� �h+ib=- y 3 ".`:::
�' Desegn Currents DestgnCarrent
Region:
Desi C-
a
acityPop,
@attie- Capacity Pop.
Wean to Finish
La erjDairy
Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
' ''
' , ` -
Dairy Heifer
Farrow to Wean
" t
�.
Design Current
Dry Cow
Farrow to Feeder1Pout
Ca aei Po .
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
GiltsNon-La
ers
Beef Feeder
Boars I Pullets I
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2_ Is there evidence of a past discharge from any part of the operation'? []Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
R] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
]g] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any parr of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes CK 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): _ ejn ZLIf f"'Ie'� 7�
13. Soil Type(s): ,�'9 .
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ]&q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes JCQ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 4 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 KA 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 J&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [K No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond M 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 10 No ❑ NA ❑ NE
❑ Yes E3 No D NA ❑ NE
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ,E] No
[:]Yes 23 -'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).
/U��`• i ��1''ti!+ "+ 'bt � l�0 r�i�firt � "�- r /l S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/tea 61
Date: - %L-4
2/4/2011

I
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: t Arrival Time: Departure Time: County: Sie�� -� Region:
Farm Name: � G -1,9p YD flOwner Email: "�"
Owner Name: �� irC�rG y Phone:
Mailing Address:
Physical Address:
Facility Contact: ; r&s,,,,1—•; " _ y � _6 y Title: efCZ2&,11— Phone:
V
41,
Onsite Representative: �d'z-�` %%�qj _ Integrator*y d�r�
Certified Operator: _/(; 4-%— r re y Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
°p Design Current
#Design Current
Design Current
Swine Capacity Pop...
Wet P ltry Capactiv'Po�:*
...
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish p�j
Design�Cuirrent --.
Da' Heifer
D Cow
Farrow to Wean_AC
Farrow to Feeder
D . P,oult `' lap-
-CactPo}
La ers
Non airy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
113eef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 B No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes �2 No
❑NA ❑N
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: g7a -fEff Date of Inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑ WUP E] Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D.No
❑ NA
Observed Freeboard (in): rj
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
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.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'EL No
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
2 No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EE 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
jn- No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):-
13. Soil Type(s):L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ycs [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [K No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®- No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP E] Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D.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
K No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'EL No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

FaciliNumber: 'L - ItL jDate of Inspection:
C77-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List strueture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JE] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
'0 No
❑ Yes
JE 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. I
Use drawings of facility to better explain situations (use additional pages as necessary).
br c e�o.��-�oa4 Gtrvtrr�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r
Date:
2/4/2011 '

Type of Visit Q<o'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit I<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'Time: ; fl Departure Time: ; t7 County Region: /4_�k12
Farm Name: //!I— V Owner Email:
Owner Name: �aNaD� 77, `t-- re__ y Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �i>nr� Phone No:
Onsite Representative: Integrator: b•; -G
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =' ❑" Longitude: ❑ ° =' = "
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
Design Currertt
Design Current
Design Current
Swine
Capacity Population Wet Poultry
Capacity Population
:.
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ NE
❑ Wean to Feeder
❑ No
❑ Non -Layer I
[91 No
Calf
❑ NE
Feeder to FinishA;
® No
❑ NA
t
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
r
�i,�
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
El Layers
El Stocker
Gilts
E] Non-Layers
❑ Beef Feeder
P_11_Boars
❑Pullets
-
❑Beef Brood Co
10
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
r
1
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
E] NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[91 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection O /�
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 9No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C0 No ❑ NA ❑ NE
❑ Yes [R 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? gl Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,rrlke - /poh: o w e ol— 74-.,- 97 o)r-- a
�'/� w�/ .3d'� /1 v,3 sk47/kl►�✓"}�I'lrJ� l/J'f� //i OY,� � l+ D'y-- /I7r.S'G' i
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ISNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VLNo
❑ 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 Do the receiving crops differ from those designated in the CAWMP?
034es
❑ 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 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
ER -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):
7.
A0 C-l>•an a -r F*� 4&"7.e-�' �� ,-Y
,rrlke - /poh: o w e ol— 74-.,- 97 o)r-- a
�'/� w�/ .3d'� /1 v,3 sk47/kl►�✓"}�I'lrJ� l/J'f� //i OY,� � l+ D'y-- /I7r.S'G' i
T
Reviewer/Inspector Name Phone: WD C�
Reviewer/Inspector Signature: Date: _Jr—, 1p A2�I p
Page 2 of 3 or- 12/18/04 Continued

Facility Number: 9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 59No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ VaT ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ba No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ 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
N 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
EM 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
Co 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawings:
J �
J
yBt4 1`1C+rd� �0 hOCN�i/ � 1ti �Cf/r p p/5o,"r—
I
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection Q Operation Review g>af-ructure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency Q-06her ❑ Denied Access
Date of Visit: Arrivai Time: ! o a Departure Time: D,' t County: Region:
Farm Name: Zn -�//J rann-3 Owner Email:
Owner Name: Pd,lek_ �: cs�z., Phone:
Mailing Address:
Physical Address:
Facility Contact: _ &I-o2k Title: �lc.re �+�_ Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification number:
Location of Farm: Latitude: =0 =1
[=111 Longitude: E_—] o =, 0
Design Current
Population
nt
MGUT—e
Wet Poultry Capacopulation
Design Currenapacity
Cattle Capacity Population
❑ NE
❑ an to Finish
❑ Layer
❑ NA
❑ Dairy Cow
❑ an to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish $
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
Farrow to Finish
ElNon-
❑ Layers
❑ Beef Stocker
❑ Gilts
-L
❑a ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures: QYJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
other than from a discharge'?
❑ Yes J6.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0. o
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: —3wrlDate of Inspection a L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes L&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
—49rG15n^-' 1.v4 6 7 1, rCJ� r ra3 ruvRJ�.S >FD r d h�` �'/ f.� � }�'�d/! r•o�
r �iri•t 64ri l� �v; w -� D� p=oc`l""�o�D Gyri r%��K?p�ce�To %`�•�
Spillway?:
A4 a�awr� 'T'5_ �5G '+ i n r• 9aC�f�og
Designed Freeboard (in): /
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
J9 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
E,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
[HNo
❑ 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
W.No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q_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):
—49rG15n^-' 1.v4 6 7 1, rCJ� r ra3 ruvRJ�.S >FD r d h�` �'/ f.� � }�'�d/! r•o�
r �iri•t 64ri l� �v; w -� D� p=oc`l""�o�D Gyri r%��K?p�ce�To %`�•�
A4 a�awr� 'T'5_ �5G '+ i n r• 9aC�f�og
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 ' I2/29/U4 Continued

f Facility Number: Date of Inspection
` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RC No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes g[ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ig 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
bZ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E[No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C,No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fig 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
[8 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�J}-� 1
/ ✓ i�Q�r%�� G✓�O C �• G © iD
r
Lr �'�- �Qa
74E)910, _,_%
l�
Page 3 of 3 11/28104

Type of Visit Ck,t0d��mpliance Inspection Q Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit CwCo/�utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: y(? County: Region:
Farm Name: V le'o" Owner Email:
Owner Name: _a.1 Vk / f e y Phone:
Mailing Address:
Physical Address:
Facility Contact: ?;!g!L Cy _ Title: 4222n 1'V ` Phone No:
Onsite Representative: integrator:
Certified Operator: `5 `� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1
= Longitude: =0=1 = u
Design•urrent
❑ Yes
Design Current
❑ NA
Design •urrent
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Swine Capacity Population
Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ Yes
❑ Wean to Finish
❑ Layer
El Dairy Cow
b. Did the discharge reach waters of the State? {If yes. notify DWQ}
❑ Wean to Feeder
❑ Non -Laver
❑ Dai Calf
❑ NE
Feeder to Finish O
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
Dry Poultry
❑ Diy Cow
❑ NE
❑ Farrow to Feeder
❑ Yes
I&No
❑ Non -Dairy
❑ NE
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
❑ NA
❑ Gilts
❑Non -La ers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Cow
12/28/04
Continued
❑ Turkeys
Other
❑Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
ZI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? {If yes. notify DWQ}
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
1
# Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?❑Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /I
Observed Freeboard (in): �0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J4 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 IR 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? ,K Yes �o [-INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes EZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LNNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 04No ❑ 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
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[H No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ 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.
in situations. use ayd�ditionGa�l pages as necess may) -T.
Use drawings of faeility to better explain
ex1
V -P— �l`a
s
PhReviewerllnspector Name ��v one: 9f33 ,33�a
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER No ❑ NA ❑ NE
the appropriate box.
❑ WIiP [:1 Checklists 11 Design C3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No [:1 NA El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jR No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Jallo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
[INA
❑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
Q.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
12128/04

Type of Visit 0, compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Region:
Date of Visit: .Arrrival Time: ; 3 Departure Time: rC� County
Farm Name: _ �z k U % PQ re S Owner Email:
Owner Name: eplt/'i E e r Y Phone:
Mailing Address: V ) a/L 1 On- � Aw ! 14 Ot
Physical Address:
Facility Contact: Xa 1PA 46 / , eACYTitle•
Onsite Representative: _
Certified Operator: 4tr
Back-up Operator:
Phone No:
Integrator:
*17
Operator Certification Number: lzg2LI
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 I = l{ Longitude: 0 0 = I ❑ u
Design Current- Design Current Design Current
Swine. Capacity Population Wet Ponitry Capacity x, Ca Cattle "Capacity Population
❑ Wean to Finish FE -]Layer _ ❑ Dairy Cow
❑ Wean to Feeder JEJ Non -Layer I I ❑ Dairy Calf
Feeder to Finish $S / ❑ Dairy Heifer
❑Farrow to WeanDry Poultry _T� 4 El Dry Cow
❑ Farrow to Feeder EI Layers -"`'�� airy
❑ Farrow to Finish =+ ❑Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets ❑Beef Feeder
❑
BoarsEl Beef Brood Cod I
}
_ r ❑ Turke s
❑Turkey Poults �
❑ Other
❑ Other �, Number+ctures
Dischar2cs & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ud No ❑ NA ❑ NE
Discharge originated at: ❑ Stnicture ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes JK No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes y No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 11/18/04 Continued

f Facility �tY Number: P'tn Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes nNo ❑ NA [:INE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Struc ure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: QLA
Spillway?:
Designed Freeboard (in): / II
Observed Freeboard (in): 0+
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JR No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
[INA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
DINo
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
EQ No
[:INA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;5 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo
❑ NA
EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No El NA [INE
❑ 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)`�1�mud_a—
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WM P? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
�No
❑ NA
EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
9 No
[INA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
DINo
[INA
❑ 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.oi facility -to better explain situations. (use additional pages as necessary):
a
519 L ,5 /<3 Al D -r -T.* 4,� �Ala v 4v % f -e S x' �
Reviewer/inspectorName Phone:
Reviewer/inspector Signature: Date: �}r'
Page 2 of 3 12/28/04 Continued

i
Facility Number: &2 739 Date of Inspection
x Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [SYes ❑ No [:INA ❑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
Fk�j No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
09 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R 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
PS No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[SNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

015livision of Water Quality v
Faciety Number O Division of Soil and Water Conservation
S8 =7�v
O Other Agency
Type of Visit ()-t,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:I �5��}}Y3r`U/ 1 Arrival Time: � � Departure Time: � i Q Countv Region: 1�
Farm Name: ` f� C4-- V r -a r -n-S Owner Email:
Owner Name: 42L C Phone:
Mailing Address:
Physical Address: f g�
Facility Contact: egot, • r l rC� 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:
Operator Certification Number: _11PkS_14>
Back-up Certification Number:
Latitude: =P 0, Longitude: 0° =1, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation`?
Discharge originated at: ElStructure ElApplication Field LlOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
16,No
❑ NA
❑ NE
12/28/04 Continued

it Facility Number: — Date of Inspection D
+o Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
i
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes PLNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -32
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes JR No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? E.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�C/ /1cw,� ✓L� f �%41n�-dt !/�' / /i � %%J%/ie�! / Gi/ r ! f/ 4�- `� y,� `� �� /C �l�I�"�
9. Does any part of the waste management system other than the waste structures require ❑ Yes
IR No
❑ NA ❑ NE
maintenance or improvement?
Reviewer/Inspector Signature: Date:
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Nr No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
20 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 types)
13. Soil type(s) :P e:2c= ii ---
—
14. Do the receiving crops differ from those designated in the CAWMP? CR Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
M No
❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
&No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IL
�C/ /1cw,� ✓L� f �%41n�-dt !/�' / /i � %%J%/ie�! / Gi/ r ! f/ 4�- `� y,� `� �� /C �l�I�"�
ReviewerlInspector Name d Phone: ,3_ri7O
Reviewer/Inspector Signature: Date:
12/28/04 Continued

1
r
r
1 Facility Number: 73VDate of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application 2q Weekly Freeboard ❑ Waste Analysis R 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
PINo
❑ 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
[K No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ 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
[9 -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
4 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
J4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U(No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AIL
213 `i`�k� s�,L .srs 1��-�� Gnd
J2 ee.�_"rQ U)cek-Pf-rr_�U" e "C7 wee f� .
12/28/04

Type of Visit ()–Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (6�koutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: C—f Arrival Time: f .��D Departure Time: D County: Region: 4210
Farm Name: X it V Q✓rNt _ Owner Email:
Owner Name:_ _1T �i t�✓ G y Phon1e:
Mailing Address: to7,' - J e/.Fe,,
Physical Address: n /
Facility Contact: �R�ffA7A �i`rt y Title:
T—
Onsite Representative: 5�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' ❑ Longitude: =0=' = W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
.tiesign
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Current
gn Current
Design Current
Swineulatiop
❑ Yes
Wet Poult ,
paci. Po'�ulation
ty. xP,.:._,ry, .
Cattle Ca aci Po ulation
P t3' P
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Wean to Finish
O No
❑ Layer
❑ NE
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Dai Calf
Feeder to Finish
3 s
❑ NE
=
❑ Dai Heifer
❑Farrow to Wean
❑ NA
Dry Pointry
t
❑ D Cow
❑ Farrow to Feeder
❑ NA
❑ NE
" "' "' " ''
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
Page I of 3
❑ Beef Stocker
❑ Gilts
❑Non-ts ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
w
Other w �°
❑ Turke s
[I Turkey Points
-
❑ Other
❑ Other
Number tafStructures:
4,Sal:�'ali'7t4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
(5No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
O 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
M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
§jNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

,I
Facility Number sy /j Date of Inspection �6
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): /5' Z2
Observed Freeboard (in): 076 6. 0
❑ Yes No ❑ NA ❑ NE
❑ Yes%ckkNo ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
[--]Yes
D4No
[--INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Z,No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
4 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
29 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
El Yes
No
❑ NA ❑ NE
maintenance/improvement?
II. 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 101bs ❑ 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 CA WMP?
❑ Yes
q No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(KNo
❑ 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
EK No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t9 No
❑ NA ❑ NE
'Comments (refer to question #): Explain any YES answers and/or aby.recommendad6ns or any'other edinrneats." .
Use drawinai of facility to.better explain situations. (use additionalpages as necessary):
7 CLev-wc.�O �z.rDuw� c'�Lo� ��t��v'�— d -n7 a� t /L�e✓�CY,�
Reviewer/Inspector Name e (amu „ Phone: �j fQ t3 3332
,
Reviewer/Inspector Signature: w Date: 6 -?"27-0
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X 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
UNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CR No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2aNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C4 No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
§qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
UNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N 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
4 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
E ] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RJNo
❑ NA
❑ NE
Page 3 of 3 12128104

l
Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit • Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 5 Date of Visit: Tune:
Not O erational Q Below Threshold
"e tted �rtified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .....+� .6.,I _.V.---. ...... ............. ............
.. County:... SQA? 1t.cl.......................... .f ?..... ...
,
............... Phone No: ..._...% '..Sgt....ga`1....................... .
Owner Name:..... et.0 ...... i`%. 'y
Mailing Address:.... . �a.........S-----•----C," „ °" N ......... 3 .... .... ................ .
J
Facility Contact: ._ ._.Dal ,..._............... Title:................................... Phone No
Onsite Representative: d].��u�._ PALL ............ ......... ...... -................................ Integrator:
Certified _....---- ...-_-_--- Operator Certification Number: • f .7g �......__._ „.
Location of Farm:
fg-Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude •
�
DesrgJn " _Current Design '11Z Design
•Current
on Ca aci Po utatiouSwine Cana . ."
Wean to Feeder ❑Layer ❑ Dairy
er to this ❑ Non -Layer I JE1 Non -Dairy
Farrow to Wean
Farrow to Feeder Other
10
Farrow to Finish Total: D Ca SCS._
gn P h'
Gilts 135 °R
Boars Total SSLW
Number alfLagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 0 -No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
❑ Yes DWo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes Dwo
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 [9 -Mo -
2. Is there evidence of past discharge from any part of the operation?
❑ Yes 0-l�o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B1410
Waste Collection & Treatment �,�/
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Imo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... ali.... _............ ✓......... ..... .... ........ _.......... ............ -- ..... - .................. ..... ........ ..... _............ ....... ............ .......................
Freeboard (inches): ') / 3 I I,"
12112103 Continued

40
Facility Number: — R Date of Inspection y a y
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes B No
seepage, eEc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes E leo
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes E3-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
Dlqo-
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Pil�o
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ANO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 0 -No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. CIop type (jcr S/t' Graffi ., D vrrsP��i J ii 11 f+�� C" zrI
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes QNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes Q -Nb
b) Does the facility need a wettable acre determination? ❑ Yes [moo
c) This facility is pended for a wettable acre determination? ❑ Yes �
15. Does the receiving crop need improvement? Domes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [moo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes ❑ No
liquid Ievel of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes DNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑Yes [}bko
Air Quality representative immediately.
Reviewer/Inspector Name /416,J( Zt rr
Reviewer/Inspector Signature: 1_1_4'_� Date: S` - / 9- o
12/12/03 Continued

I#
Facility Number: _ 39 Date of .Inspection S I o
Required Records & Document,~
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?
(iel WUP_,d ec is , desLgg"ap�etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste AF -1 ❑ Fr b d ❑Waste ysis ❑Soil pling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
'es ❑ No
❑ Yes QNo
❑ Yes SS
❑ Yes UNe
❑ Yes 9 -Mo
❑ Yes 9 -No
❑ Yes 9 -N -o
❑ Yes 9 No
❑ Yes 04
❑ Yes 9 -N -o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttonai Cammeets Wings.
A.
Cmil/.'.?Ve c, e sp GiOl�nd
J
rc er
e �]� sej'� �i/f ✓P P/1 IAUPFF/I
y hF tvc��/c✓/ ao�
mdr'c.
%�o�s :nv� �� ✓c Gc �P�m, T C�Pn Paul ar cr �r� /.'/'cu�c d
CUVpIa9c ecac.;e vJ` )44e plj lU�loUn moo! 6r.'n, L/OSNd' C��T
SG Ys, sai'1 L G f J
c/
Is,'„�
/dgdC)n
T
12112103