820400_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f ' Arrival Time: t Departure Time: O Od County: 5060
Farm Name: p r� Owner Email:
Owner Name: Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: t � Integrator:
Certified Operator: Y Certification Number:
Back-up Operator: i o y ones Certification Number: 1 1 Ro
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
n.
Wet Poultry 'Cap caa ty Pap.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Non -La er
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
D . P,onl
Design Cnrrent
C•a acI Po
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Layers
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Pullets
a Turkeys
OtnerAcTurkey Poults
Other Other
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation?
❑ Yes
r No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
1T NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
❑ No
TP 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
�j NA
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
Tg
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NI
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

acility Number: Date 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
[B 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 Lp 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 ❑ NF
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 0 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? T
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 Wind
ow
❑ Evid04ai
nce Wind Drift ❑ Application Outside of A )proved Are
12. Crop Type(s): CC � I
13. Soil Type(s): /VOA_
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
[P
❑ NA
❑ NE
❑ Yes
P No
DNA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
D Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (Ij No 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes m No
❑ Yes No
❑ Yes No
❑ Yes [P No
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑-
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes i No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 1j] No ❑ NA ❑ NE
- r additional recommendations or any other comments.
Comments {refer to question #}: Explain any YES answers and/or any ad y
Se [ir8WIII of�facilr t0 betterex 1,,. .° S � �, Ili,{i, . ^J161I}��� , 11°� 1,111 I '�� � yi.al �I��i'Vr, r.JC11
U gs ty p am situateous (use add�ttvnal pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2 4/201 S

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Q Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: DZ% h Departure Time: FQ3; fY% County: egion:
01
Farm Name: �� Owner Email:
Owner Name: �/-�$ G� Phone:
Mailing Address:
Physical Address:
Facility Contact:
r
Onsite Representative:
Certified Operator: eit2ajL Qtitil Y
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: ,.a /�
Certification Number: d 3 ` LL 6
Certification Number:
Longitude:
urrent esr D gn
Swine - Wet Poultry Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish Layer
Dairy Cow
Wean to Feeder Non -La er
I
Dairy Calf
Feeder to Finish_
Dairy Heifer
Farrow to WeanDesign
Current
Dry Cow
Farrow to Feeder _ �.00 , Pout
Ca aci
l;o
Non -Da'
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 L�Wo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes qNo
OVA ❑ NE
0 NA ❑ NE
A ❑ NE
HNA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facl Number: - Date 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
P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - 33 ' A,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;!q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement? TT
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 ❑ Faiture to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of \Vind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes
)m No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
Lp No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes . �lo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
­7
Use drawings of facility to better explain situations (use additional pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:9%(> j
Date:
214.12011

Ii ype or v tstt: W compttance i nspectton U uperatton xeview U ,tructure Evaluation U t ecnmcat Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency _O Other Q Denied Access
Date of Visit: Arrival Time: Q Departure Time: 2' County: sWj4P_W Region:
Farm Name: c112, Owner Email:
Owner Name: S ►1 s Phone:
Mailing Address:
Physical Address:
Facility Contact: T"^^�_S Title: Phone:
4i JJ -
Onsite Representative: Integrator: rvS'l�
Certified Operator: � sz. / Jaw Certification Number: 172 b
v
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Currentt
DesignCttrrent
Design Cuerent
Swine
t?apactty�
Pop Wet'Poultry
Capactt Pop. _:
Eattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
=
=
_:.. ;
Dai Heifer
Farrow to Wean
Design
Cui-rent
Dry Cow
Farrow to Feeder
D , Il?oultr,
Ca aei
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boats
Pullets
Beef Brood Cow
Tor ke s
Other
,:$�`
Burke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No K] NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
Fa NA
❑ NE
❑ NA
❑ NE
DNA
❑NE
Page I of 3 21412014 Continued

Facility Number: -q jDate of Ins ection: !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: 9 — 3
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 23 1 ✓
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
[—]Yes ® No
❑ Yes P No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes W No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EP No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes $D No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? TT��
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable%C,ro �Window ❑ Evidence of Wind Drift ❑+ Application Outside of Approved Area
12. Crop Type(s): sit { 'r+�-GWS j �fTg -Xj"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
1$_ Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA [] NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes `7" No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [RNo ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:]Yes [P No
❑ Yes 99 No
❑ NE
❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 199 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ]� No
❑ NA
❑ NE
(Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f /3
21412014

type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[teason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name: vii,_
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Arrival Time: JZ:gO Departure Time: Q i County: �t.�oso.-It) Region: 420
Owner Email:
L,
Phone:
Title: Phone:
Integrator: 1L�
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Desigu Carrent
Design
Current
Design Current
Swore a. Capacity Pop. _
.Wet Poaltry -
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
I
11-ayer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
M 0,
'
Kt - y
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 FNo [:INA ❑ NE
❑ Yes
[] No
O NA
❑ NE
❑ Yes
0 No
0 NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
1W No
❑ NA
❑ NE
❑ Yes
tp No
❑ NA
❑ NE
Page I of 3
21412014 Continued

Facili Number: - Date of Inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: —
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 1 i�2 4 r
S. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure S
No ❑ NA ❑ NE
❑No 'PNA ❑NE
Structure 6
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[]NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
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, etcr
❑ 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. Clop Type(s): COGSQ G:;T, - & ), 's Cr..' � . - a ",/
f r �
13. Soil Type(s): 4 m I - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
1 S_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
9
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �N No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

1F'aciliNumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 1� No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted 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?
(refer to question 4):
gs of facility to better
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YES answers and/or any addil
situations (use additional pages as
❑ Yes 09 No
❑ Yes No
❑ Yes No
uns or any other,
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
Phone: 9 f'o -y3,? 3l �
Date: I a l �l�
21412014

ype or visit: qVi.ompnance inspection V vperanon review V atructure r,vamanon V i ecanicai Assistance
Reason for Visit: • Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ( 2 Arrival Time: $ r Departure Time: :30 County: s_C*j
Farm Name: P V� _ Owner Email:
Owner Name: Tv-a!Br4eC t Phone:
Mailing Address:
Physical Address:
Facility Contact: �aA-0 S Title:
I4
Onsite Representative:
Certified Operator: :ME
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Tr-e5
lof=
Certification Number:
Certification Number:
Longitude:
Region: r_�
I'
eat
Design Current
DesigntCur
Swine
U'DgnCurrent
c ty Pop.
Wet P ultry
Capacity Pop
Cattle Capacity Pap.
La er
Non -La er
Da Cow
Da Calf
Da Heifer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
2 p
Q
Design Current
D Cow
Farrow to Feeder
D . Poult .
Layers
Non -Layers
Pullets
Turke s
Ca aci P,_o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
Other
Turkey Puults
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 P No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
[:]Yes
❑ No
[] Yes
No
❑ Yes
yEn
(1 No
NA ❑ NE
NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: $ Date of Inspection: t(/?,!113
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J�jNo
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Strucre6
Identifier: t3- — C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �I V It3.2 a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
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?
T
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
0
[:DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
P 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 Accepta
12. Crop Type(s):
Crop Window
l�kka i
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
S
SGO
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes 1P No
❑ Yes 1P No
❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection: tj 2 L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes PNo ❑ 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 1P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes f P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
(Comments (refer to question ff): 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/lnspector Name:
Reviewed]nspector Signature:
Page 3 of 3
Phone:
Date: {i/�4 43
21412011

I
G— 377
- Di'vision of Water Qaality
Facility Number - DD ©Division of Sail sad Water Conservation fdr i 1 ' 13
�+ Other Agency
type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[lesson for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: .`3[7 County:'Region:
Farm Name: t j }t; r�C _ _- Owner Email:
Owner Name: K 'i r k _Fu e!= i7 �, Phone:
Mailing Address:
Physical Address:
Facility Contact: 6f "', L' L ;7�- Title:
Onsite Representative: 571t.. 9
Certified Operator: %p
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �/r31, r�
' T
Certification Number:
Certification Number:
Longitude:
._ p'
Design -urrent ;
Design Current Design Current
Swine
Capacrtyr .Po .x
Wet Poultry
Capac�ty,l'op
Cattle', Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish,-.
:.
Dairy heifer
Farrow to Wean
%�2
16 rrent
Dry Cow
Farrow to Feeder
D , lioultr
Ca aci i?o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars Pullets
Other
Turkeys
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
[ ] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Jw No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Ins ectioa:
/
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No
❑ 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: �; 2 s yrcr _ '77ves 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
® Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ` ❑ Evidences of Wind Drift ❑ Application Outside of Approved Area
I
12. Crop Type(s): corn /Wh �� /fn�.��-�z..S� / _%jr�'�s�W— / Ov"'j,� _
13. Soil Type(s): J(f t')& L f� .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes In 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 Co 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 [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L2g 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. [A 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? [Z Yes [-]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No
❑ NA ❑ NE
❑ Weather Code
fa Sludge Survey
NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - D Date of Inspection: /
f
24. Did the facility fail to calibrate waste application equipment as required by the permit? [N Yes ❑ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
[Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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
� No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes ®. No ❑ NA 0 NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
CK No
❑ NA
❑ NE
❑ Yes
P, No
❑ 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 explain situations (use additional napes as necessarv).
(,(f/r r ✓1. �a /in f .5 G'N �1 �� (il/�ul �v � Ld 1��) 7.�.f'r. Co ✓ � O rC 4 [,p� ��5 G/t ar ram' 3�,
;011'i.
;1--4
7�� S�C,coiy� SKf✓� ,
C�14w,�,/ .s ��tl�t rrJ�l J� Gv r` � l 6 � �ti ✓�- c
Reviewer/inspector Name: S'J Y
Phone:
Reviewer/inspector Signature: f _ _ Date:
Page 3 of 3 21412011

Date of Visit:
— Arrival Time:
0; Departure Time: !3[7
County: j✓�
Farm Name: ��tr!%�;/"
Owner Email:
Owner Name: �
% � st//yjs'
�n G , Phone:
Mailing Address:
Physical Address:
Facility Contact: AvJ Ahn-ty 7\ l e'k Title: Qu.ol r/ Phone:
Onsite Representative: 15__"t�
Certified Operator: _ I.,, -mil.
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: -0,
i
Design Current'
Design
Cugent
Design C*urrent
Swine
Capacityy Pop
Wet Poultry
C►apacity
Pop
Cable Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
'
Layer
Non -La er
I
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
D , P.oult .
Ca aei
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ata
Turke s
Other
Turkex Poults
Other
rTOther
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 [:]NA ❑ NE
[] Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
Page 1 of 3 21412011 Continued

Facili Number: - (70 Date 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 [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes fS 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 g No
❑ NA
❑ NE
& Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M 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.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [j 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):
IF
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?
Required Records & Documents
❑ Yes 0 No D NA ❑ NE
❑ Yes ® No D NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 No
❑ NA
❑ NE
the appropriate box.
❑ WL1P ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Dl7 Date of Inspection: —,oV//
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Eg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes 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 drawings_ of facility to better explain situations (use additional pages as necessary).
1,3
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

i
ivision of Water Quality S'1J�� '�
aFaciiity N ilber „� a Division of Soil and Water Conservation / — 3— f
-- 0 Other ZMyP_
Type of Visit
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: Arrival Time: Departure Time: � County: Region:
Farm Name: r Owner Email:
Owner Name: �azA" rR, 1�Q G• Phone:
Mailing Address:
Physical Address:
Facility Contact: Ad %Qeyo k ; r K Title: 0-WAPhone No:
Onsite Representative: Integrator:tvl
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = . = Longitude: I=] o =1' ❑
Design Current
Design Cur:.ren#
Design Current
Swine Capacity Population
�'et P©nitry Capacity Population
Cattle Capacity Population
❑
Wean to Finish
❑ La er
❑ Dai Cow
❑
Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑
Feeder to Finish
❑ Dairy Heifer
®
Farrow to Wean
"� `�
Dry Poultry
❑ Dry Cow
❑
Farrow to Feeder
❑ Non -Dairy
❑
Farrow to Finish
❑ Layers
❑ Beef Stocker
❑
Gilts
❑ Non -Layers
❑Beef Feeder
Boars
El Pullets
rE Beef Brood Co
�....,.,...::-
❑ Turkeys
Other
❑ Turkey Poults
Number ofi Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9LNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E&No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection ID
' 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 I&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.3 per. �Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
®,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage.. etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
5ZNo ❑ 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
FM 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 El
No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo ❑ 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) / »ems � 1C)y 4�5e-,.-� Cd�.RvL / !! lt�, SF3r �
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
21 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
29 No
❑ NA
❑ NI?
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
{R�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):
�a✓► 1,s � b�-� �rT TEE %S �r ► �f �i ds �,��z �✓' � � ye -a--
Reviewer/InspectarName �� w Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: p Date of Inspection t1�7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CE No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ERNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
g,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PLNo
❑ 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
VIVO
❑ 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
19 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
Da 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
Additional Comments and/or Drawings:
w
Page 3 of 3 12128104

f
A,
c�
ivision of Water Quality
='2ei1it=y_
Division of Soil.and Water Conservation
� Other Agency
Type of Visit 12r6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
a Reason for Visit 0 Routine cpeomplaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: OD County: Region: J
Farm Name: --a21-re1) J5_ 14�_/ Owner Email:
OwnerName: %V W 71 >�GzrmPhone:
Mailing Address:
Physical Address: Y
Facility Contact: i Title: Phone No:
Onsite Representative: Obie - r, PC Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 00 ❑ g =gd Longitude: =o =1 = 1i
Design Current Design Current
Design C*urrent
Swine
Capacity Population Wet Paultty Capacity Popul� hen
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wea toFeeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
--_
==_..
❑ Dairy Heifer
Farrow to Wean
4'= •- -
D_ ry Poultry - -
❑ D Cow
❑ Farrow to Feeder
-
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
❑Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
.:
❑ Turkeys
Qther
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[:1 Yes
JR] 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
C9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
54 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection r�
i
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 ❑ No ❑ NA ERNE
❑ Yes ❑ No ❑ NA ❑ NE
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 EM 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 [ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA ® NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA R1 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA ® NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA ff NE
maintenance/improvement'?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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
n NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ No
❑ NA
ERNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
ONE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[3NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
91 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):
� 5 ► ` 4 F ��5�� ��l m�r� �- 7qr y / . 6; - &w 5 5eo/7w& 5
51�� I�' �P • � � v� aac�5 rerof46 , t9it) r ®�s�7acvn_
Reviewer/Inspector Name�Phone:
ReviewerAnspector Signature: Date:
Page 2 of 3 12129104 continued

r
Facility Number: — ©ate of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ;a NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA gLNE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ❑ No ❑ NA SNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
IQ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
LK NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
aNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
RNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
91 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
❑ 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
09NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,l Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
!,k, I i �7t 1 --up utr a- A D/1r�d� C'e p%f c -__�s �7��, .-.- :45WT
Page 3 of 3 12128104

I
Division of Water Quality t
Facility Number d 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit om iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: !O Departure Time: County: Region:
Farm Name: 4Q/'1``e1),-, Owner Email:
Owner Name: W & UJ1:� % r K _��CM6 —E719 C : _ Phone:
Mailing Address:
Physical Address:
Facility Contact: JGtj r t r1, _ Title..
Onsite Representative:
Certified Operator: _5011R _
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 �74t"_Dl
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [= 1= Longitude: 0 0= t=«
Design Current Design Current
Capacity Population Wet Poultry; Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system'? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes qNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
El Yes
❑No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection �S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /�Z 0 3 � 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IM 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 EjNo ❑ 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 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 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
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
tZ 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
0 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
�
66fryt- Fn V`,
Reviewer/Inspector Name �� -- Phone:
Reviewer/Inspector Signature: Date: 2 -�
Page 2 of 3 " ` 12IZ8104 Continued

Facility Number: — Date of Inspection �g
1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I&No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes tA No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ® Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ® 120 Minute Inspections ❑ Monthly and I" Rain Inspections 9,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 10 No ❑ NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[K 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
R1 No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91 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
® 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
[kNo
❑ NA
❑ NE
General Permit? (iel 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
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Pi f W UIOj CFV!
FA
W Division of Water Quality
f Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: J `tt�tJ Arrival Time: Qr30�All
y Departure'I'ime: 'f/4County: SQIN Region: FkO
Farm Name: CT+lirr 11( �&kt/ko' Owner Email:
Owner Name: NowklrkFaws lnr� Phone:
Mailing Address: aitl t Q 9 G Off Lad_ _HUTOI1& ul, a$q53
Physical Address:
Facility Contact: NIke. Nieiyk�_ Title: F�tM Hmafr Phone No: Cho- o@g`%4[01(( )
Onsite Representative: Integrator: COr1Si91 P1t71h 1"urkf
Certified Operator: w Operator Certification Number: _ + Q3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = . ❑14 Longitude: = o ❑ { ❑ u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: aj
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 J�Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E[No ❑ NA ❑ N E
[]Yes XNo ❑ NA FINE
12128104 Continued

FaciUty Number: , — p
f
Date of Inspection
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:
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 19 _ 1
Observed Freeboard (in): Q o -9ip �S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EWNo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
YNo
❑ 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
EgNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9No
❑ 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
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N 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 Acceptabiq Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
nr%
12. CroptyPe(s) WheQ C Mti
or-41 61A ®S
13. Soil type(s) No A do B
.._.__.,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
12No
❑ 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 acre determination?[] Yes
D4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
$�-No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
wr
Reviewer/Inspector Name Z70 A af I:ffi � � Phone: [phone]CO
Reviewer/inspector Signature: Date: _la y I 1 I 1�100�
12/29/114 fnntinrwd

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9F No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �jNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. (^Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard %Waste Analysis El Soil Analysis El 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
5tNo
❑ NA
❑ NE
❑ Yes
D. No
NA
❑ NE
1KYes
❑ No
❑ NA
LINE
❑Yes
5allo
El NA
❑NE
❑ Yes IVNo ❑ NA ❑ NE
❑ Yes ❑ No JKNA ❑ NE
❑ Yes 5? No ❑ NA ❑ NE
❑ Yes P9 No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CKNo ❑ NA ❑ NE
❑ Yes EFNo ❑ NA ❑ NE
3 F'fib C alt+$W - -fail Cori seyer4n n '� 'f-o Conch a
1R-e4ds-hl1 Corn seyb-wS ej, , Sorbea s M-4yIt har„e;, W 1p,,wasmed+-00i
Yel
140-7 +0 5)1.1107 , Yya,�eAlak jer ced 6oc1 frt-1
.ati, Gad 1� Vvo��4�e�4�na�se� ttro�►�, y y 9 (CVrrPri- wog �a� f r i � QA I'ei , Uos war d,,,r, lp Done -7 Ia�o-
is � } �
Plebe- loep clvr yields-brsfaa P1d1 rv�k`h re tordi ,
soil SOA fka- C1We in 4)007
.�vte
p. Slvd_ 6vrvt '}�o� Gtdne- � eid d`P qr. aooWs�,we�Yvasdoti�
.53� was � lr �7 ho b p`f
U 3 beih Yvilj 'P1 ot,-�,+StfVf showf
r n D II M br Ar{} ? vE
if N
A �.
y, f" o�fjce,wh��o�►d.
12128104

r ,
- ®Division of Water Quality
Facility Number 3Z_ 0 O D visj n ofSoil and Water Conservation
��Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 5' Z Z Arrival Time: / :,,Z Departure Time: Z County: Region:
Farm Name: _ �[7 vi-e- fl/y # - Owner Email:
owner Name: A1,eW 1,,4 F;VA4 S l NG Phone -
Mailing Address:
Physical Address:
Facility Contact: ,,'' ++ Title:
Onsite Representative: t�a. W
Certified Operator:
Back-up Operator:
F1_0
j� /1 Phone No: (/
Integrator: COG-5C, 1 fI p lal ►�.� PO V-Kl
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n [= 1 = « Longitude: = o = I I=] it
Deslgn Current�Design�
Current
Design Current
S,wme
Capacity Population
Wet Poultry �YCapacityY Population
Caul, Capacity Population
❑ Wean to Finish
❑ Layer
19
� ❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
El Dairy Heifer
12
D Poult
ry ry
s"^
❑ D Cow
El
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Non -La ers
El Beef Feeder
❑ Pullets
❑ Beef Brood Coal
r
^*
Other,.. +� I
z`
❑ Turke s
❑ Turke Poults
,..:
❑ Other
❑ Other
Numberwof.Struetures:
�.,
Farrow to Wean
2
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
. El Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? ([f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ Ni~
❑ NA
❑ NE
❑ Yes
�j No
❑ Yes
[,N No
❑ NA
❑ NE
❑ Yes
;U No
❑ NA
❑ NE
I2/28104 Continued

/r -
.i
Facility Number: gZ —l�Cpp Date of Inspection -22 `D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[)d No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ONo
❑ NA ❑ NE
Structurlo Structur90 Structurao Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 /9
Observed Freeboard (in): 2 _ 30 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
[WNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifts ❑ Application Outside of Area
12. Crop type(s) CD 5��1 _ Sp �a[¢Af-$
13. Soil type(s) n%D7VV4; 1 fZ
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment`? ❑ Yes
�No El NA El NE
[$ No ❑ NA ❑ NE
XNo ❑ NA ❑ NE
E�No El NA El NE
Reviewer/inspector Name ►:v Phone: ��o(v
Reviewer/inspector Signature:A�A Date: ,�_—ZZ— ZDO (�
rage z of S 1L/14a/U4 uonunuea

Facility Number: 13z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Um No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ElOther
2t. Does record keeping need improvement? Ifyes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(%No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
N NA
❑ NE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Pfl No
❑ NA
❑ NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CS NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 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
,,ma�yy
[A 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
f0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
w
Page 3 of 3 12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine Q Complaint O Follow up O Emergency Notification O Other Q Denied Access
Facility Number pp Date of Visit: 1O -IS'o Time: U
O Not Operational O Below 'Threshold
9Irermitted Otertifiyed 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: -- --
Farm Name: _._j F, 4� r ( #a _ _ _ - County: .Sa'mgjge) ... . _ � _...
tau
Owner Name: _.. j. zRt J _ .... _..!yea . .. _. .. Phone No: _.___rj / O - ?R y - o 87 `f r .. .
Nailing Address: - I� q - -N- 4 - - �f14�
Facility Contact: _ry, Title: _._ Phone No:
Onsite Representative: /t! .11� _ Nt �.•'� lC -- Integrator.
Certified Operator:____Cam-9 e. _.� W ., ��� %� Operator Certification Number.
Location of Farm:
(wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �'� Longitude �• �' �"
Destgn Current r -Des:gu Current ' _ curresit
- . .. Cattle SwinePo &on �4p�ltty Po on.
Wean to Feeder Mayer Dairy
Feeder to Finish Non -Layer Non -Dairy
arrow to Wean
Farrow to Feeder <_� Other
Farrow to Finish
Total DeOgn`.Capaciity
Gilts
Boars To ai:SSLW
L> Number ofFlacvo!ns
Dischanes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes BNo
Discharge originated at ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes B No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes [-f'No
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 ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 2 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -D_
Freeboard (inches): Lf
12112103 Continued

Facility Number:1,2. Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 2
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes 2/No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public stealth or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M'f4o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes a No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑Yes [30
elevation markings?
Waste application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes E No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 9-fqo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
!3� !US Ac
I2_ Crop type C'o.,,7, Wl,r. t . Se xve ns
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes '2,N0
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes M-No
16. Is there a lack of adequate waste application equipment? ❑ Yes SNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 53�No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes G*o
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 [ 446
Air Quality representative immediately.
C.ammmts {recr to�goxx:#)F aay �z/or aay, or any ot� oaf_
c =
i3se drawmg'faa"l�ty W 1`lertam suns.,{pge as r [�'F`ieid Copy ❑ Final Notes^
New k,'.1c le -is ;4se of 44e 44, r P I
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sAhd efoo:e Ira�fi Gf SPO^ G} fie Gct v/ TA I rs arof fl, ;
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Nun /A�yJ �o• ,►,uw [,.rdv.,dr �"�e fie .� �4a f�9oe,�
Reviewer/Inspector Name _ i - r : = s� _' a . _ - w =
a ]( `Q_ _,
Reviewer/Inspector Signature: Date: J o- I S - c�

Facility Number: pp Date of Inspection fl i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Tes
❑ No
22. Does the facility f ' to have all components of the Certifier) Animal Waste Management Plan readily available?
(it! Wl , ch i ts, d gn, is, etc.)
❑Yes
B'No
23. Does record keeping need improvement? If yes, check the appropriate box below.
9-Yes
❑ No
[:]-Waste AppHeati ❑ 0-36il Sampling
q-13 D.9•f� o.rs s-11 7 U•y`/ 0./7 tj O.3G,
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Eo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
®Wo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
Flo
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
❑ Yes
[No
28. Does facility require a follow-up visit by same agency?
❑ Yes
E- Woo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9,90
NI MES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakeis on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34, Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crap Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Cerdfcation Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

D Dw�s�on"of Soil and Water Canservahan � ''
�'� 4},:x '� ti�� r� � :-�• � �} '�; Other A� encv. ��s o �; ��ryJ 3 .� `<���k �:f � fj-€'YS? i'S.!.� Yt �'�.t�A� �.7m�ai '� r� �' .
a .:. t 4*.r.'t,�srt.3 ;,. .... <�...-..-r�-. a. _. ...s Y.l :. -.i ..._.._ . '"u.. },..f a., 3' r i. ,•''_45.'.n h-c:....,n .,frr ,�'. :�1.
Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 132 400J Pate of 1'asit; 4/2/2004 finx': 11:35
ro Not O erational 0 Below Threshold
® Permitted ® Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: Tarr UsA.1................. Count%': SAAnPwill........................................... ERO .............
Owner Name- ------------------------------------------ -------- Bl&&.Ritxej-.Xa.r.ms.,.LLC................. Phone No: 9.1.0-532-4729...
...............................
Mailing Address: R0].)3ox..l......................... .. ... ffaXmUs..NC.......................................................... 211 . ..._....
Facifity Contact: ......Fide: ......................... ................. Phone No: _-.....-
Onsite Representative:...................................................... .. Integrator: ......................................................................................
Certified Operator: IS.eA1ty.N............... ................. KaA.t :.......................... Operator Certification Number: J94. .....................
Location of Farm:
1.7 miles east of421 on Hwy.41 on the left behind Feed dill
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 a 43 36 Longitude 78 • 10 ° 36 K
Design Current
Swine C'.anarity Pnni lation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
1250
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 1
Design Current Design Current
Poultry' PopulationCale yCapacity Population
❑ Layer ❑ DairyI I ----]
Non -Layer Non -Dairy
❑ Other
Total Design Capacity 1,250
Total SSLW 541,250
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
.a. If discharge is observed. was the conveyance man-made"
b. if discharge is observed, did it reach Waicr of -the State? (Ifyes, notify DWQ)
c. If discharge is observed. what is the estimated flogs° in sallmin'?
d. thies discharge bypass a lagawn system'? (If ves, notify DWQ)
2. Is there evidence ol`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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus stonn storage) less than adequate'? ❑ Spillway
Structure I S1ruC1U1-e 2 Structure 3 Structure a Structure 5
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Identifier: ......................................................
Freeboard(inches):................................................................................................................................................................................ ...................................
12112103 Cantinnod

c,--
Facility Number: 82-400 Date of Inspection 4/2/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or (] Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
[] Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
1 I. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Pond ing ❑ PAN ❑ hlydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination'?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern'? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments, ;?
Use draiviu s of facility to better explain situations. (use additional pages as necessary):
g h' P ' P g r'Y)� ®Field Copy ❑Final Notes
Visited the faun with Paul Sherman to evaluate innovative design. &
Reviewer/Inspector Name Larry Baxley Paul Sherman
Reviewer/Inspector Signature: Date:

Information contained in this database is from non agency sources and is considered unconfirmed.
Animal Operation Telephone Log
DWQ Facility Number $2 _ 00
Farm Name IHarrells #1 J
Caller's Name Jim Moore
® Reporting 0 Complaint
Callers Phone # [phone]
Access to Farm
Farm Accessible
from main road 10 Yes O No
Animal Population
Confined 10 Yes 0 No
Depop 10 Yes O No
Feed Available 0 Yes ONO
Mortality 10 Yes O No
Spray Availability
Pumping
Equipment
10 Yes O No
Available
Fields
10 Yes O No
Date 8-12-2003
Time 9:00
Control Number 3994
Region JFRO
Lazoon Ouestions
Breached
10 Yes O No
Inundated
JoYes O No
Overtopped
10 Yes O No
Water on
EO Yes O No
Outside Wall
Dike Conditions
10 Yes O No
Freeboard level
Freeboard
Plan Due Date Date Plan Date Freeboard
Inches
(? equals blank) Received Level OK
Lagoonl 18
8/14/2003
V -I i b
Lagoon2
Lagoon3
Lagoon4
Lagoons
Lagoon6
-----1'Yl.r:_...�'f'1_a�rt..�_.._.�.� �1.�..�'----��-�--�--.._�.=..�.�f_=..�.�_._.�:-.�_.....:�����.�'_.._._�_..�_.._.._�.�?_.g.a.o.;?s.._..�.�►_�..
{ -` 9
. J pp
person tailing catlC Larry Baxley
• i - i_5 Tl;,c ?r � 4. f. ,'t ! x �,: Zr �� - .. �.- t � _ �!,_ � 119 ? _ � _ i 'zi'i,
Comments2

Facility Number
flat. of Visit: ime:
�i
Not Operational 0 Below Threshold
Permitted © Ce 'filed [3 C nditionaRy Certified El Registered
Farm Name: rr`e II.S —,41—/ _
Owner Name: 13 1ar. I ✓er rGrP?S. C— _
Date Last Operated or Above Threshold: _
Count.: S/¢'3yLr)SD�s
Phone No:
Mailing Address:
t
Facility Contact: 6 o re Title: w n >° Phone No:
Onsite Representative: 4,111 A. to r Integrator: 6—OW A -s
Certified Operator: n I' 1 DO r-e, Operator Certification Number: j 3 �(3
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 4 Longitude
Design . Current ': Design Current Design . Currept
Swine Ca self Po ulsteon '_": -Poultn Ca achy Population Cattle Ca actri• ;_Po elation
❑Wean to Feeder
Feeder to Finish
Farrow to Wean
Z [�
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Nurnber of Lagoons
Holding Puads 1 Solid Traps
❑ Layer ❑ Daja
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity j Z 5—d
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Total SSLW
1U Subsurface Drains Present
❑ No Liu uid R`aste ManaQen
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed; was the conveyance man-made?
b. If discharge is observed, did it reach Rater of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
0
Area JU Spray Field Area j=.
❑ Yes No
❑ Yes
ElYes;No
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XfT
❑ Yes
No
❑ Yes
No
❑ Yes
%-40
Structure I Sture 2 Structure 3 Structure & Structure 5 Structure 6
Identifier: '* ;?---
Freeboard (inches):
05103107 Continued

Facility- Dumber: z DO Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over appI' t-on? ❑ Exc ssive Ponding El El Hydraulic Overload
C 12. Crop type !Orm Pa
13. Do the receiving crops dill with those designa d in the Certified Ani I Waste Management Plan (CA'VNN
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLUP, checklists. design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified ANVNIP?
❑ Yes �No
❑ Yes 14 No
❑ Yes to No
❑ Yes Too] No
❑ Yes No
❑Yes No
❑ Yes t No
AA4er i
❑ Yes No
❑ YesJ'No
No
❑ YesNo
El yes
❑ Yes �,] No
❑ Yes P No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes lNo
❑ Yes No
❑ Yes No
❑ Yes No
IRNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to_question #): ExplaW any YES-ans ers and/orlan) reeommetid"ons or aav other.comments. V
Use drawings of facility to beiter eiplaiii situations: (tise additional pages as necessary} '- ❑ Field Conv ❑Final Notes
Gt1 e7#aJ I t° cL-C r-es i S be; .. w o r'ke 0 �--- ,6 I y /y%u r/ 1 B.� w ••- .
Z�
R W o �oI t S 0.-I s n w o r kt ti5
Reviewer/Inspector Name SA
Reviewer/Inspector Signature: Date:
05103101 V f Continued

Ey
Facility Number: - OD Date of Inspection Z pL
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
Iiquid Ievel of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes i[$ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or y�
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes , No
l
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

of Visit
Reason for Visit
Compliance Inspection O Operation Review O Lagoon Evaluation
Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number = Date of Visit.
[%Permitted 10 Certified [3 Conditionally Certified [3Registered
FarmName: ............. 1.6.eus....0--/.........................................................................
Owner Name :.................................................... ... I " ' S
❑ Denied Access
7 b l Time: l: 3 O
Q 'NotOperational Q Below Threshold
Date Last Operated or Above Threshold: -.. .. . - _..
County: .........��...mp.;P ?el .................. - .... -- ..
Phone No:
Facility Contact: ...... .FgO4..... 1« ............................... Title: ........ OWA:sf.................................. Phone No: ................... ........ ........ ........ ....
MailingAddress: ................................. .............................................. ..................... -� ...... .
Onsite Representative• KPltf t i�c�f ......._.....-------• ....................... Integrator:......--- w n _.......... �— -- _.._.........
_
----.... .......... .
Certified Operator - -------------km a.4. jt: f�............... .. Operator Certification Number:.... �'.. 3 .� ...
Location of Farm:
IYSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 64 Longitude ' �«
Design.' Current Design Current Design _ Cmreat _
S*nne.,_ `- Ca Po viaaon Poultry Ca ci Population Cattle _ ._'Po #on, -
Wean to Feeder ❑ Layer FE
Dairy
Feeder to Finish ❑ Non -Layer Non -Dairy =
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
❑ Gilts
Boars Total SSLW -
Subsurface Drains Present Lagoon Area Spray Field Ares y
Number`oiLagooffi ❑ ❑ P 7
HoldingPonds / Soiid Traps .: I❑ No Liquid Waste Management System` 4
Discharges & Stream Impacts .
1. Is any discharge observed from any part of the operation? ❑ Yes to No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c- If discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes t-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: ............................................................................................
Freeboard (inches): ?
5100
❑ Spillway ❑ Yes 10 No
Structure 4 Structure 5 Structure 6
Continued on back

b,
Facility Number: — I.100 Dime of Inspection 7
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes) No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes J No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ((No
12. Crop type Co cn t3lha # 5c r' Yr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes IP No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Required Records & Documents
17.
FaiI to have Certificate of Coverage & General Permit readily available?
❑ Yes
M No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONO
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
VYes
QW
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
10 No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
IN No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
:
-1qiQ[S As 60$ -yi0rA 0010 •vtre 00fe!o 006ft tW'vWjt! • Yoo will •teoiyc do futlht r :
66r4&Sooridence:aboutthL'Svisit:::::::..•.•:•:•:-.•.•.•.•.•.•.•............::... .
aa- AFree6X4 (ex-1 L,�`s �d1 as q" on 5/'3/'01. Nc, rf-C,4
r1/Q f='tlilA��O�'1 IJWQ l`C U lyd o!%y-11"he- 14-UJ5 9FP 4)11.J ! +
`" AV_T P�vy - grown k_X>1 'ni on Cjkqit
Reviewer/Inspector Name �� 41.' u t Y
Reviewer/Inspector Signature:Date: O 5100

Facility Number: — qpe Date of lnspection v 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [Z No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes %No
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 1W No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Off No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
hp -umments an or= rawings- - ...
J
5100

Drv�s>ion of Water (Zuahty
0 Divrsion of Soil and Water Conservation
O Other Agency=
w
Type of Visit (j) Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
- r Facility Number
Date of Visit: %z 7 `Time: � Printed on: 7/21/2000
� �
Q Not operational Q Below Threshold
® Permitted '® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .......................
,ll'..:.... County: rO.0
Farm Name: ................... , :..........:.............................................................. ..............................................
I�_ J
Owner Name:........! .. tom...... r ?� � Phone No:..... / U�l...�3�...... ��.. �.............
7 L
Facility Contact: .22.�....... � axiE...........................Title .. .... .. Phone No:...................................................
MailingAddress: �........ �... .......................... .............................................. ..........................
OnsiteRepresentative :.._.•.�[!.1.. - We, 5, z-� Integrator:...... OC
Certified Operator: !?� /� . /F,ar. Operator Certification Number: ..........................................
,t'
........ ...............................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 .6 Longitude ' 4 44
DcSign Current
Caoacety %DlllatiOn
Wean to Feeder
Feeder to Finish
Farrow to Wean
2 ,�-D
2�U
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nnfa a of Laggons
H >i}ding:Ponds' j Solid Traps
Design Current D6ign Ciirr'ent
Poultry Capacity Population Cattle, Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present 110 Lagmm Area
No Liquid Waste
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observer]. what is the estimated flow in gal/min`?
d. Does discharge bypass a lagoon system:' (Ifyes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
l) Spray Field Area
❑ Yes ,kNo
❑ Yes 14NO
❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure Structure 2 Structure 3
Identifier: � ...1../ it ..
..................... .............. ..-_......................... .
❑ Spillway
Structure 4 Structure 5
................. ................. ......... I...................
❑ Yes No
❑ Yes ,� No
❑ Yes ®'No
❑ Yes A'No
Structure 6
Freeboard (inches):
5100 Continued on back

Facility Number: (?7— C Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? XYes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designat din the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violaiiQris. .deficiencies were pQtea di>Fritng his;v...... will t eceiye Rio; #'ui-th. .
'rorrespottidence. aboutt thus .visit` .. . . . .. .. .
❑ Yes P'No
❑ Yes �TNo
❑ Yes JRJNo
❑ Yes ffl No
❑ Yes )9] No
❑ Yes �&No
❑ Yes No
❑ Yes No
❑ Yes P9 No
❑ Yes (KNo
❑ Yes ;R�No
❑ Yes ","No
❑ 'Yes ',Id
❑ Yes `EZNo
❑ YesNo
❑ Yes No
❑ YesTo
❑ Yes K] No
❑ Yes (j No
❑ Yes No
Comments (refe'r to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings .of €/a;e'ty to better explain silt-u%ations. (use additional pages as necessary):
/�` .�� -/' i7,.� f�1/`'�% ��"`�' O�'� ��y j✓��-YC [J C�/� ,�.GGI�//�%'� ��//�L1CJiu+ �+���f A.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 1-2/? 211- • 5100

J,
Facility Number: Date of luspection /'Fa
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below O'Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,UNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes PSNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NJ -No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? N Yes ❑ No
J

Ito
D.�M.._ ,. � e ;Drams:onsoffSoil a�td?Waier•Conserva�on, _:Operation Review„,�,�-�.=�•...'��'?.�'1� ._sr.�j,{,� ��
Q Routine Q Complaint p Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 74 hr. (hh:mm)
0 Permitted q
Certiifiie�d� [] Conditionally Certified 0 Registered 13 Not Operational Date Last Operated:
m Farm Nae: 1(-'ure..l� .... r........................................................................ County: ......... ��?!�.�....?1�.......t 1:......................
Owner Name: J " ,..-l� Phone No ,� ^ s�c� — 1
..............1--- ............... .....-----.---....................--..................................
r ./................................
FacilityContact : ..............t !l!) .......... 1`�---.--.-. ................. Title:................................................................ Phone No:................ ...................
IVMailing Address:. .. f -10 Ax.... ! .............................. .... ...f - �1-.�� ....'A.....0................. ..4t�Z..z.
i
Onsite Representative: ............................................... Integrator: ..................�fi�'r�'}�
Certified Operator:..................K!�kl...................................... Operator Certification Number:---....--........--.......................
Location of farm:
............................... ..................................................................................................................................................................................................... ....... ........ .......-..-------------
Latitude 0 ��� Longitude �• �° 0°
Design _Current Design Current Design Current
Swine � „_._ _,_.w-:, �._�_ - - .- - _
_ .._.. - Capactty.,Po ulahon .M.,:Poultry, Ca aci Population.- Cattle Caliact ."--Po' ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean 5CD =
Farrow to Feeder ❑ Other
❑ Farrow to Finish I Total Design capacity--T.
❑ Gilts
❑ Boars Total SSLW
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes (No
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estitnated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identi I ier: :ff1 #- A
It it
Freeboard (inches); ,,,,,,,,,,,,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 01No
❑ Yes[XNo
❑ Yes O No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
❑ Yes 4NO
Continued on back

Facility Number: — V60 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement`?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type IN�y
13. Do the receiving crops differ with those desigYated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
{ie/ WUheeklis , desig ,maps c.} ✓ /
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste anal sis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fait to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
GVtn�rD
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0:-1o•yi61h0Oris:oi7le�iClen'ctes -were notedd&itig tliis:visiC- Yotk will•ireeeiye trio fut Ur
correspondeiice. abotif this visit:
❑ Yes [� No
Yes ❑ No
Yes No
❑ Yes 0 No
❑ Yes E�No
❑ Yes 0 No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O No
❑ Yes Eg No
❑ Yes 0 No
0 Yes ❑ No
❑ Yes ONo
❑ Yes {� No
❑ Yes /❑ No
❑ Yes JXNo
❑ Yes � No
XYes ❑ No
Use drawings of facility.to better explain situations. {use additional pages as necessary) �,
-- -._ �.n_._.
�. 4,-
w'
I /j saNv a a"e O
Reviewer/Inspector Name _ _� _ _
Reviewer/Inspector Signature: %fi�� ,+r4z'ps7��� Date:
3/23/99

I Facility Number: — �� Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNO
o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
u., -UOU
ClP�rm
cp, nfrrz� jz,,� 6w4J' 4,/ 4,
3123/99

IV
* Via^"' u€ � �,sr'ski:3;wi`a�'�.�.C:.'".eoa.�:.«"=�.G���..✓��i":i"r::._... '�`xi:�rad�k a:�-vr�gaA�F'q na�,ro:,;Bs .rr x;
❑ Division of Soil and Water Conservation ❑ Other Agency
,{ �J Division of Water Quality'
L Routine O Complaint _O Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection KM
b4Time of Inspection24 hr. (hh:mm)
13 Registered © Certified 0 Applied for Permit [3 Permitted 0 Not Operational Date Last Operated:.........
FarmName:.:..........f!r!t � ............ .. County:............ S,f .'............................... ...I...................
y
Owner Name:.......... f /4.../..�tfg............................................................... Phone No:�.....`'�` .' ! 1%.' ? ...................
Facility Contact: ......�0. ! ..... .. Title: --.. Phone No:
Mailing Address: ......1.:...0.........�.,�.._..... /... Y51...........I........................ ..........................
AE�
Onsite Representative: .......... 14!7Pt!✓/.......IT�....................................................... Integrator:......... 1�.....__ iit' .:........................
Certified Operator;.......... -I .......... 'V...................................... Operator Certification Number.,........................
Location of Farm:
a
Latitude • 04 0 iL Longitude 0• ' 0"
Design Current " Design; Current' °A
:Destgtii Gin.— "w
Cap4a Popalaaott-Pauitry ,Capacity.:, Popi lation <� Cattle
Capacity4Populahon
❑ Layer Dairy
J,...
-. ❑ Non -Layer Non -Dairy
FE]
" ^` "�¢'R"'4'^ .yi °�a4j�'
wa.,,.lY' �..
fit- yam+•.
❑ Other w, k
g<SD
Wit,
�'� ` Total-D6ign Capacity
Tata1 SSLW
• r:
Number of Lag`oons`1zHoldtiig Ponds ❑ Subsurface Drains Present ❑ Lagoon Area p Spray Field Area ;
- - -
�, r 1 Li;;id Waste Management S stem
❑ No I.
7, ¢`
q g Y
#r f:
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
1Z
I D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes � No
2. Is any discharge observed from any part of the operation? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes A No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes RNo
c. If discharge is observed, what is the estimated flow in gal/inin? �ti/�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes IQ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes V No
4. Were there any adverse impacts to the waters of the State: other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [i'No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Ni No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes RQ'No
7/25/97

� n
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons,Holding fonds. Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 446 f
............I...................... .................. .......... _.................. ��°................................... ....... ....
Freeboard(ft):..............-;.�..........................� .... ........................ p ..... ..............................................
10. Is seepage observed from any of the structures?
1 I . Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancclimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the Stake, notify DWQ)
Structure 5
15. Crop type ............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted_ Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0: No.violationsor" deFciencie's.wer'e noted -during this:visit.- Yoi 4ill receive•no' further,
correspbndence atiout this'visit - :
❑ Yes
V No
❑ Yes
XNo
Structure 6
❑ Yes
KNo
❑ Yes
KNo
❑ Yes
XNo
XYes
❑ No
❑ Yes
KNo
....................................
❑ Yes
�Vo
❑ Yes
Q No
'Yes ❑ No
❑ Yes ,U No
❑ Yes No
❑ Yes No
❑ Yes kNo
❑ Yes U-No
❑ Yes 9No
❑ Yes kNo
7/25/97

DSWC Animal Feedlot Operation Review 33,
`
{ f DWQ Animal Feedlot Operation Site inspection =°
tf ®xa xA f .a,oue t;'k£' ar gg 'off fi -
"x'a-T% ..:. .. .:.< .... ...—. u ...-..-.<,...,..,,: a...:�.. .....,._.......:..-,�:.:M...,.......�.w.ro�.: .:. ... ...-.,.>..,.r.�,......-... ,... .... ^�'4� xY,.tiRo-�mn ,bw.e�exu
,x rm z
® Routine O Complaint O Follow-up of DIVO inspection O Follow-up cif DSWC review O Other
/07d-C�
Facility Number Date of Inspection P'
Time of Inspection 24 hr. (hh:mm)
M Registered © Certified [3 Applied for Permit E3 Permitted [3 Not Operational Date Last Operated:
Farm Name: �0— l t i M County:.... Soa!r.............................. _ ....................
Owner Name: a.&.V,- ..... Phone No:....... 3 Z -
Facility Contact: ......40A.1k....... .................................... Title:.........................
Mailing Address:....... ...........
.................
Onsite Representative* ......... ,-'1't ,�+'�....�ip.....-....
..........................................
................
Certified Operator: ................... ............ ...............................
Location of Farm:
........... ................. ...... Phone No:......... ........................
{?eJ..,...1...0.................................. .........
Integrator:......................................................................
Operator Certification Number: .......................................
Latitude 0 C6 Longitude 0 6 .4
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Ivs o
17 D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current'
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons/ Holding Ponds 10 Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
General
I . Are there any buffers that need maintenance/improve ment? ❑ Yes No
2. Is anv discharge observed from any part of the operation'! ❑ Yes No
1)i�char c uri�inatetl at: ❑ La-oon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made '! ❑ Yes ® No
b. If di char,. ly observed, dill it reach Surface Water? notify- i)WQ) ❑ Yes ® No
c. If di.5chartc is observed. what is the estimated flow in -gal/min"
d. Does dischars.e bypass a lagoon st�stetn? (It ye , notify DWQ)
❑ Yes
Q No
3.
Is there evidence of past discharge from any pan of the operation?
❑ Yes
ERNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5_
Does any part of the waste management system (other than laaoons/hoiding ponds) require
❑ Yes
® No
maintenance/improvement'?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
T
Did the facility fail to have a certified operator -in responsible charge?
❑ Yes
VLNo
'25/97
Continued
on buck

Facility Number: ax— rfpD
8. Are there lagoons or storage ponds on site which need to be properly closed"
Structures (Lap©ons,floldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus stortn storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: ........-..-...........-a2..................
Freeboard(ft): ..........� ............................. .............. ...... ..2L..................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application.'
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
❑ Yes JW No
❑ Yes '0 No
Structure 5 Structure 6
15. Crop type GO.&s.....S..r VftC►...7...tsr.ke.r .......... .................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2 L Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
❑ No violations or deficiencies were noted during this:visit. You will receive no further
correspondence. about this. visit:
❑ Yes 1WNo
❑ Yes 01 No
59 Yes ❑ No
❑ Yes RNo
❑ Yes 19 No
w
❑ Yes ® No
® Yes ❑ No
❑ Yes 19 No
❑ Yes lA No
❑ Yes MNo
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (ir`efer.to question #): Explain any YES anssi,ers and/or any recontmendations.;or any. other comtnents
Use` drawin s of facility to better explain situations. (use additional a es as necessary
.Y
uw
_ S j
{-9C,Q�y�'�. Ste' Qhd�2.sJ� �RitACiYl� p��l 1 S [N �� �i.r�{ I4,
CJ-O5ioVn pr�t�[RrMs
l
coke X4CAJ1 a�j JVZ V,
Svrt�u,Ym .
7/25/97
Reviewer/Inspector Name14
& _,
Reviewer/Inspector Signature: Date: III L&-z

Site Requires Immediate Attention:
Facility No. 7 a - 40o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing
County:
Integrator:
On Site Representative: 1�
Physical Address/Location:
DATE: - z 7 , 1995
Time: /,oO %/
Phone:_ 9/O — s34 --5�-7, 9
Type of Operation: Swine x- Poultry Cattle
Design Capacity: - - Number of Animals on Site: J- //92c'
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have suf ie freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or
Was any seepage observed from the la oon
Is adequate land available for spray? Yes
Crop(s) being utilized: s .�
Does the facility meet SCS minimum setbai
Y (7) Actual Freeboard: Ft.±Inches
►? Yes or 1�o Was any erosion ob ed? Yes or(P
No Is the cover crop adequate? (Ke�2br No
criteria? 200 Feet from Dwellin s? es r No
100 Feet from Wells? I e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o<0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 00
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi( If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
i�/TT-
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

State of North Carolina
Department of Environment,
Health and Natural Resources Y15;A1
4 •
iFayetteville Regional Office
James B. Hunt, Jr., Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIROPII+l WAL 3MANAGEKENT
November 9, 1994
Mr. Ralph Ezzell, !Manager
Murphy Family Farms, Inc.
Harrells Farm
Route 2, Box 81A
Harrells, NC 28444
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Ezzell:--- -
On November S, 1994, an inspection of your animal operation was performed
by the Fayetteville Regional Office (FRO). please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A KCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you -have any questions regarding this matter, feel free to contact
me at [phone].
Si cerely,
�
Grady Dobson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Gary R. Scalf
Wachovia BdIcUng, SLite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
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i
KOEr$ CAROLINA DEPARTMENT OF ENVIRGIDOW, HEALTH & NATURAL RESOURCES
DWISION OF AL MAC
Fayetteville Regional Office
Animal operation compliance Inspection Form
Ralph Ezzell, Manager
Harrells Farm
Murphy Farms, Inc. 11/8/94 HA1
Route 2, Box 81A
Harrells,"NC -28444
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
Animal onerationIhme•
Horses, cattle, aw , poultry, or sheep
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation GISTRAT M?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a PMTIPTM A1VI_lOIL
PASTE MANAGF.l+1F.W1 �
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

J CTION III
Field Site anagement
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
5. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _1= 5 ft)
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION N
Comments
ream:
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Section II (4): This facility was existing prior to the end of 1993 and will
not be required to be certified until the end of 1997.
Section III (4): A certified plan is not yet required; however, a cover crop
is established and a BMP plan is being implemented.
J1

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr_, Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
gK Farms
Harrells 41
PO Box 1
Harrells NC 28444
Farm Number: 82 - 400
Dear J&K Farms:
April 17, 1998 REC -q��� ,
1098
�iAYET TEi�(�� E
_
You are hereby notified that Harrells 91, in accordance with G.S. 143-215.1 OC, must apply for coverage
under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty (60) days to
submit the attached application and all supporting documentation. In accordance with Chapter 626 of 1995
Session Laws (Regular Session 1996), Section 19(c)(2), any owner or operator who fails to submit an
application by the date specified by the Department SHALL NOT OPERATE the animal waste system
after the specified date. Your application must be returned within sixty (60) days of receipt of this letter.
Failure to submit the application as required may also subject your facility to a civil penalty and other
enforcement actions for each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal Waste
Management Plan Certification Form. If any of the general or operation information listed is incorrect please
make corrections as noted on the application before returning the application package. The signed original
application. one copy of the signed application, two copies of a general location map, and two copies of the
Certified Animal ]Waste Management Plan must be returned to complete the application package. The completed
package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Mike Lewando,.vski at [phone]
extension 362 or Jeffery Brown with the Fayetteville Regional Office at [phone].
Sincerely,
�, A. reston oward, Jr., P.E.
cc: Permit File (w/o encl)
Fayetteville Regional Office (w/o encl_)
R.O. Box 29535, Raleigh, North Carolina 27626-0535 "telephone [phone] FAX [phone]
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