820401_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental dual

Type of Visit: aCom ace Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _^ Arrival Time:j 9 -'YET -1 Departure Time: L,
I County: , ��—
Farm Name:r �— �., i51. , //O—Owner Email:
--
Owner Name: t} Gt � %J rp,�a fnt� G, L G Phone:
Mailing Address:
Physical Address:
Region: �-0
Facility Contact: Aee-,I Title: j ��� mac. Phone:
Onsite Representative: Q f i�r//yJ�UO� (f ; rr, Integrator: �
z
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ar ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWiZ)
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 ZrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Design Cpr�ent
❑ NE
Design$ ,Current
AMA
No
Design Current
Swine
Capacity
Pop.�Wet Poultry
Capacity Pp.
Cattle Capacity Pop.
Wean to Finish
Laver
paia Cow
Wean to Feeder
DCS
-D
Non -Laver
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Cnrent
Dry Cow
Farrow to Feeder
D Poul
Ca aci Po '";'
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
TurkeysIF
��l i
i�4�1i'
Beef Brood Cow
;kIPniSr 'elr'
Otherd,? �
i u
Turkey Poults
�
OtherOther
P l�j�
tEs
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ar ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWiZ)
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 ZrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

I+acili Number: - U Date of Inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []"'�_es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [j'l10 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4/I Structure 5
Structure 6
❑ NA
Identifier:
❑ Yes
to
❑ NA
Spillway?:
❑ Yes
[ -lqo
❑ NA
Designed Freeboard (in):
Observed Freeboard (in): _� /19/ �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[-I 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
[]'Ilio
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
[T No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
Ej_'N_o
❑ 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
[nNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O—No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptableCrop Window ❑ Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):c/�f- Z�/�zYa�s
13. Soil Type(s):
a
i
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
[n No
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
[ -lqo
❑ NA
❑ NE
❑ Yes [3 --No ❑ NA ❑ NE
❑ Yes EaVo ❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
❑ Yes [3 1Qo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes ET o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: v ( pate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permiIt conditions related to sludge? If yes, check ❑ Yes Ej No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �lo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑N
❑NA ❑NE
❑NA ❑NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes []"No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [�No ❑ NA D NE
❑ Yes E]<o
❑ Yes [3'No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Used wilt`{gs of facifer lity ni:nenclations or auy,:other earrements
ty o better explain situations additional ons (use adtional pages as necessary).
14 to d-4 � rd
7—/r,, — L r- I
CUfY�L-ianC'V_- IN�!'`�•�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: �UyJ tXs�
Date:
21412015
0
!tea
I
14 to d-4 � rd
7—/r,, — L r- I
CUfY�L-ianC'V_- IN�!'`�•�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: �UyJ tXs�
Date:
21412015

l
iivi 0-a of Water Resources
Facility Number ®- Di O+ Division of Soil aIN
nd Water Eonservatiou
l� Other Agency ,
Type of Visit:�om�pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (3 xoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: : 3 O Departure Time: ; 3 county: Sym Region: (I T— O
Farm Name: Owner Email:
Owner Name: ��-���C;,r� L �- G Phone:
Mailing Address:
Physical Address:
Facility Contact: ��' �'��r,/ I%�c)d r -L Title:
Onsite Representative:
Certified Operator: CTvA
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
a
Certification Num r:`�'yc0
Certification Number:
Longitude:
Discharjes 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
DNA
❑NE
❑Yes
❑No
❑NA
0 N
Design
Correct
u _
Design
Current Design
Current
Swine
Cappaaeity
Pop ,i
'We Poultry¢
Capaetty
Pop �3 Cattle Capacl.
Pops
F�QWean
Wean to Finish
Layer
Dairy Cow
to Feeder
o o
e2 C:) °
on -Layer
Dairy Calf
Feeder to Finish
0
3c)­s—
Dairy Heifer
Farrow to Wean
° Design
�I��
Current Dry Cow
Farrow to Feeder
1 'L. . ::
D Poul
Ca act
N;7E
Pl�f. o P. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
3
Turkeys
Other
Turkey Poults
Other
Other
Discharjes 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
DNA
❑NE
❑Yes
❑No
❑NA
0 N
❑ Yes ❑ No
❑
Yes }[� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

4 Facility Dumber: - 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 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: u�j �i n �5--►�
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E. No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in): _ ,}SY
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
[] NA
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
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EINo
❑ 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
2. No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes allo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window / ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s):
13. Soil Type(s): L- y/24&5t-
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
[::]Yes
M'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E. No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
[] NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 j0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12 No
❑ NA ❑ NE
❑ Weather Code
D. Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: YO Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gj No
1 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [[No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
RNo
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
E, No
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
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ANo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a No
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA []NE
Use drawg
in t n . Explain ao YES answers an.d/or any additional recommendatiiom or any other comments.
Comments (re.:: �fer to facility
..,
of facilli to better expplalain situations. ase additional pages as necessary)..r
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone:
Date: /,,;Z— / 2 — / 7
2/4/10!5

�l ype of visit: Q Compliance Inspection t) t)peratton Kevlew U structure Evaluation U I ecnnical Assistance I
Reason for Visit:outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Time: ;ITC Departure Time: County:���-L�Region:
FarmName: ,` t-i�, u f Owner Email:
Owner Name:; v`�o/—G�✓t7�tj t' �- Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: / �r ���cC , Phone:
Onsite Representative: �rr� C� / hz ►'+^-yO✓`Z -
Certified Operator:
Back-up Operator:
Integrator:
Certification Number: z2 L(O C7,0-
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current �Destgn Current# Design Current
We
tPoultCa asPo Cattle. Ca aci Po
Swine Capacity Pop: - p. p ty p.
WE Wean to Finish La er Dairy_Cow
Wean to Feeder I jNon-Layer -- Dairy Calf
Feeder to Finish Dairy Heifer
r�
Farrow to Wean Design Current D Cow
Farrow to Feeder .. P ' _ � pa
D . �Poultr Ca achy =_Eo P. - Non -Dairy
Farrow to Finish La ers Beef Stocker
+:
Gilts Non -La ers Beef Feeder
Boars Pullets 13ecf Brood Cow
Turke s
Other Turkev Poults
Other Other
Discharp,es 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 0,,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes allo
❑ Yes M No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

]Facility Number: - Jq j Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
Designed Freeboard (in): /
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z_No
❑ NA
Observed Freeboard (in): C) 3 I
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
0 Yes
O -No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
t2. Crop Type(s): GDI-ri— /wlf
13. Soil Type(s): /I
n C1__
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
JZ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z_No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
E] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WEIP E] Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Iryes, check the appropriate box below. 0 Yes [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes allo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes MNo ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facili Number: - Date of Inspection: — G
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 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JE] No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes
�No
❑ Yes
[D�No
❑ Yes
2[�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signatut
Phone:
Date: 7 �L
Page 3 of 3 21412015

Type of Visit: fp Uompliance Inspection U Operation Review U structure Evaluation U Technical Assistance
Reason for Visit: GrAoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: lL,l�-1-I Arrival Time: ; aim Departure Time: 3 i p'O County: j�5�__
Farm Name: �QfCoco/� tzf to Far. -t. Owner Email:
Owner Name: ;5�,,k TK Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,n(l- f
Onsite Representative: ,,�_ irn MO -
9111 -Certified Operator: Zr.
Phone:
Integrator: Al 3
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued
- �
Design Carrent
DesignCyrren
t., �
Current
Swine Capacity Pop.
Wet Poultry
Capacity, Pop.
Iign
Cattle city Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder p
Non -La er
Dai Calf
Feeder to Finish
,...
Dai Heifer
Farrow to Wean
s�gCrent.
D Cow
Farrow to Feeder
D , P,oANNacii
4Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other -
Turkey Poults
Other
Other°
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

Facility Number: - O ( 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
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
[DNA
❑ 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 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evideence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): a. - h
13. Soil Type(s):de
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking 0 Crop Yield p 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 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 2/4/2014 Continued

Facility Number: - t4 c)(71 jDateof Inspection:
r 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32- Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paces as necessarv),
Reviewer/Inspector Name: v �� Phone: 5k -lie -22-3J20
0
Reviewer/Inspector Signature: _f Date:
Page 3 of 3 2/4/2014

Type of Visit: ompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: elioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: Departure Time: County:
Farm Name: C'D.�G¢�I� ! � - Fn i ;,.., tea/ _" Owner Email:
Owner Name: - -crc ; r-" r—.,vFH� / / G Phone:
Mailing Address:
Physical Address:
Region: jt�;ie_
Facility Contact: map/`— Title: 1/L !fe_, Phone:
Onsite Representative: f G� ` ; .y.—s.7 /&o / `C Integrator: iV�h�y �YfjW i^�
Certified Operator: {/ ; m p��r Certification Number: Qa
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [&No ❑ NA ❑ NE
❑ Yes
Design Current
❑ NA
Design
Current
❑ No
Design Current
Swine
Capacity Pop,
Wet Pouitry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
OD
Non -La er
Dai Calf
Feeder to Finish
9 co
Dairy Heifer
Farrow to Wean
-
Design
Current
Dry Cow
Farrow to Feeder
D , Poul
Ca aci
P,a
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
- -
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

Facili Number: - Date of Inspection:
1. Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[K No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2/�%% Structure 3 Structure 4 Structure 5
Structure 6
Identifier: k 7- /1=717%5,[y -+r
.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): AID -
I V5.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
(K No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(s): C';�i
13. Soil Type(s):
14. Do the receiving crops differ from ose designated in the CAWMP?
❑ Yes
E3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑'WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Ag=reements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �9 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: / —
1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El 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 [Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a 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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
0 Yes [Z No [DNA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes ®.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: —&—./ �? ;A91'
2/4/2014

Divi"sioa of Water Quality
Facility Number ®- �
M*of Soil and Water Conservation
0+ other Age,ncy
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: t�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f— --%3 Arrival Time: 3 Departure Time: County: Region:
Farm Name: C&3 C'�,jr A&,,
Owner Email:
LIZ
Owner Name: Phone:
Mailing Address:
Physical Address:
- Facility Contact: G I<l'e-! .V0e7 _ Title: Y r�
Onsite Representative:./L1D/� �aiclkj+/1C0z3/`C_
Certified Operator: Jr"n
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: %1'LCr
Certification Number:�llQ�
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'! (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CR,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
DNA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes U No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
Design
Current..- Design
Current :
Design Current
Swine
Capacity
Pap ._ `. Wet�l'oultry '. Capacity
Pap
Cattle Capacity Pop.
Wean to Finish
ILayer IDairy
Cow
Wean to Feeder
fl
Non La er
Dai Calf
Feeder to Finish
3vt b
€ ._F;, .:: '`
Daig Heifer
Farrow to Wean
-° Design
Current
Dry Cow
Farrow to Feeder
.D 4PoW Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_-
Turkeys
Other
-Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'! (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CR,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
DNA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes U No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: Date of Inspection: It- 7—I
Waste Collection & Treatment
4. Is storage capacity structural plus storm storage plus heavy rainfall less than adequate?
Yes
No
NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
J
Identifier: /UYl->`�-%5/Es-�
Spillway?:
Designed Freeboard (in): C�
Observed Freeboard (in): '02 Ir
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[g No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
IM No
VbL
❑ 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
25 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[KNo
❑ 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
�g_No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Approved Area
/
12. Crop Type(s): 4 P E-t
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[K No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[K No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[S-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 El 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. 1f 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 3 214/2011 Continued

Facility Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tA No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Vj No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
0 Yes [g No ❑ NA ❑ NE
❑ Yes 54 No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7 : 3D-' /D -'30
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�.3� 33��
Date:
2/4/2011

Type of Visit: ErCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Dlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a Departure Time: County:
Farm Name: Owner Email
Owner Name: ZLr, /� ; ✓ Phone:
Mailing Address:
Physical Address:
Region: 11I,
Facility Contact: Title:% Phone:
Onsite Representative: �'� ('r/YloOrr- Integrator: �,r
Certified Operator: 7; ,►-I '0I op/ --z— Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
.ry,.
❑ No
❑ NA
❑ NE
Yes
[E No
❑ NA
�.
Design Current
❑ Yes
Design
Current
Design Current
Swine
Capacity Pop.
Wet.Poultry
11
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
op 6Do
Non -La er
Dai Calf
Feeder to Finish
Dr>
� �
"`
""
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Point .
@a achy
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow--
owTurke
s
Turkeys
Other
Turkey Points
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 allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
[E No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
[:]NE
Page I of 3 2/4/2011 Contused

Facility Number: jDate of Inspection: — /—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2/I Structure 3 Structure 4 Structure 5 Structure 6
Identifier: v1,- j n.. S /
Spillway?:
Designed Freeboard (in): 9— /51
Observed Freeboard (in): 2.3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed andlor managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
® No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
21 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)
the appropriate box.
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 [K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G in �- �r.� 3
13. Soil Type(s): Iry
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
l5. 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 [!g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements [—]Other:
2l. 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 C No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -j0V1
jDate of Inspection: ZZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2 No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ 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
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Co 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 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/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�J 3 330
Date:
2/4/2011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ADrikoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L- / Arrival Time: Departure Time: County: g -L- Region: 3(7
Farm Name: 1�-�LrtS-P17• ��� s -t r �/� �� Owner Email:
Owner Name: �f +a �k l� ; Vtr T ari7ls �- �. G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: SdYC� Phone:
Onsite Representative: & r -m ap/r- O' * Integrator: zgk Dzg j
T
Certified Operator:: rn -Pie _ &pp/� Certification Number: /Z,;;hf DO
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [-]No
[:]Yes ❑No
[:]Yes ❑No
[:]Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
0 N ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 7 of 3 21412011 Continued
Current
Design -Current
, r Design C-9-r—rentiIIIII
_Design
Swine= Cap ity Pap.
Wet Poultry °
Cpacttrop;
Cattle Capacity Pop.
Wean to Finish
iry Cow
Wean to FeederNon-La
er
Dai Calf
Feeder to Finish
-
-
Dai Heifer
Farrow to Wean
_
r Design Current
D Cow
Farrow to Feeder
Dr= Poeiltr
Ca'act=Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
—.Non
Pullets
I Beef Brood Cow
Turkeys
Other _tet
Turkey Poults
^"
Other 101
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [-]No
[:]Yes ❑No
[:]Yes ❑No
[:]Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
0 N ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 7 of 3 21412011 Continued

Facili Number: V -p Date of inspection:
J
❑ Yes
No
❑ Yes
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: /NIR/"•
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ® 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes[yC]
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 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 42er
13. Soil Type(s):
_ v
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?
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ 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 ® 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 [j� No
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [EL No
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Q 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 Co No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge Ievels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [Z No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes '2 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
(9 J(4� ei--�� jo-� eLt- 4
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
Phone: p— 33`'j3t?o
Date: — (o �a7II
214/2011

i
Type of Visit &�ffi pliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Ar/rival Time: DC7 Departure Time: ' County: Region:
Farm Name: �tiG of r_ )Viz ✓'S-z:A7 tf' �yr�► i5� L�--� Owner Email:
Owner Name:_2V=r. 5 1-L __ Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title: a
Onsite Representative:
Certified Operator: _
Back-up Operator:
�OYilc, Phone No:
Integrator: IWLIk
Operator Certific tion Number:�O
Back-up Certification Number:
Location of Farm: Latitude: = o =I Ell, Longitude: = ° ='
Design Current
Design -Curren#
Design Current
Swine Capacity 1?opuration
Wet Poultry Capac,ityPopulatian
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ Layer
[] Dai Cow
Wean to Feeder a DU110
Non -La er
❑ Yes
❑Dai Calf
❑ Yes
NEeeder to Finish 30rO a gpp
❑ NA
❑ Dai Heifer
❑ Yes
❑ Farrow to Wean
Dry Poultry - :
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
❑ Gilts
Boars
Other
❑ Turkey Poults
❑Other
Numbeures:
❑ Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R1 No
❑ NA
EINE
❑ Yes
®-No
❑ NA
❑ NE
Page 1 of 3 12128/04 Continued

Facility Number: — Q I I Date of Inspection 142�7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Alme'4=
Spillway?:
Designed Freeboard (in): 1 �F
Observed Freeboard (in): 1 a�
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.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
' No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
91 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
.®No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s) irl,-et /
13. Soil type(s) L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
' No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Yek4 raj'
Feel-Aw toocjur rn ;73 6r5My ��rs 11;1`f
Was
T
�,lr.
Reviewer/Inspector Name f ,� Phone:
Reviewer/Inspector Signature: �' ��_ Date:
Page 2 of 3 12128/04 Continued

t Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box. ❑ WJp ❑ Checklists ❑ Design 6 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'!
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
Cl NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[KNo
❑ 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?
El Yes
� No
❑ NA
❑ NE
1 f yes, contact a regional Air Quality representative immediately
31-
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JgNo
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
allo
❑ NA
EINE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z[ No
❑ NA
❑ NE
Additional Comments and/or,Drawtngs. _ h
Page 3 of 3 12/28/04

S—Z—NS 17 -zZ - zoo 9
Type of Visit O"tompliance Inspection O operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lZ'«-09 Arrival Time: I 10C004i— I Departure Time: x}:00 County: SQ••pso.j Region: FAA
Farm Name: Cas CCLA C, l'ru rse_n4 Owner Email:
Owner Name: B 1 ae K -iy e r E0Lv-*,% L L C Phone:
Mailing Address:
Physical Address:
Facility Contact:
G r e.e. r M oo re -
Onsite Representative:
Certified Operator: MOOK_ A►��5 e.
Back-up Operator:
Location of Farm:
Title: Tccl. - SP�� Phone No:
Integrator:
Operator Certification Number: 22-4 00
Back-up Certification Number:
Latitude: =0 =1 = u Longitude: =0=1 0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'_I No ❑ NA ❑ NE
❑ Yes
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Papulation
❑ Wean to Finish
❑ NE
El Yes
❑ Layer
❑ Dai Cow
® Wean to Feeder
Z&OO
L(,pp
❑ Non -Layer
❑ Dai Calf
® Feeder to Finish
YDO
Oo
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
ElGilts❑ Beef Feeder
PO
Boars
Pullets
ElBeef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (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 L'_I No ❑ NA ❑ NE
❑ Yes
❑ No
L"I NA
❑ NE
❑ Yes
❑ No
ENA
❑ NE
SNA
❑ NE
El Yes
El No
❑ Yes
ONNo
[:1NA
ElNE
ElYes
BIN o
❑ NA
❑ NE
12128104 Continued

e
Facility Number:
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 Jr Z Structure A! Structure 3 Structure 4
Identifier. P-P51-i,vS Auiesu-i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 Z Z
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes U No
❑ Yes 2<0
Structure 5
❑ Yes
❑ Yes
L7 No
LI -No
❑ NA ❑ NE
El NA [_1 NE
Structure 6
El NA [I NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes BNo El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks.. or compliance alternatives that need ❑ Yes ZNO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]0% or l0 lbs ❑ Total Phosphors ❑ 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) Count
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?
❑ Yes
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
[ffNo ❑ NA ❑ NE
LTJ No ❑ NA ❑ NE
Z""No ❑ NA ❑ NE
&No ❑ NA ❑ NE
El No ❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name 171- E Phone: 9/0.*33,3300
Reviewer/Inspector Signature: Date: 12 -/7-2-00'7
I2/28104 Continued

i
Facility Number: 82 — #01 Date of Inspection
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L+1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
21 No
❑ NA
❑ NE
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NA
❑ Rainfall ❑ Stocking Cl Crop Yield [:1120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑
Weather Code
❑ Yes
L7 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
lJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
[:1NA
[:1NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[IYes
B' -No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
ZrNo
[INA
ElNE
33.
Does facility require a follow-up visit by same agency?
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�,/
L'7 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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
,.,�
L7 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
,.�/
Ld 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
ZrNo
[INA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
AdditionalComm nt or
...=
12128104

✓ &rAs i -o8 -o4
ivision of Water Quality
L=1=FaCiffNmberuI - Division of Soil and Water Conservation
Other Agency
Type of Visit (3r-C-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Sen- Region: /�4
Farm Name: L,4 �C'_ad ►�y5�-�+�isGi�v� _ Owner Entail:
Owner Name:LLC. Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 re -4- /11ao-k-t_ Title: ��- IW
Phone No:
Onsite Representative: GrGc-+� Atoore-- Integrator: IWO &J -1d A/
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
= = Longitude: =11=' ❑ u
Swine
Design Current
Capacity Population
Wet Poultry
Design Cu.' ent
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
["NA
❑ La er
❑ Dairy Cow
Wean to Feeder
Q
❑Non -La er
❑ NE
❑ Dairy Calf
eeder to Finish
I 2(9b6 I
allo
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
``��'
Dry Poultry
❑ NA
.a ElD Cow
El Farrow to Feeder�
y
- i° w
Non -Dairy
ElFarrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ Non -Lavers
=� [I Beef Feeder
❑ Boars
❑ Pullets
.010
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
I
❑ Other
Number of Structures:
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes O -No ❑ NA ❑ NE
❑ Yes
❑ No
3'�IA
EINE
❑ Yes
❑ No
["NA
❑ NE
D -NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[-Ko
❑ NA
EINE
12/28/04 Continued

� 3
Facility Number: 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 1 Structure 2 Structure 3 Structure 4
Identifier: NUyS FLJ
Spillway?: NO A10
Designed Freeboard (in):
Observed Freeboard (in): Ct
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
[:1 Yes [.�,,N�o [I NA [__1 NE
El Yes LTNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O ivo ❑ NA ❑ NE
❑ Yes L'1 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [T No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E3<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,��
4. Does any part of the waste management system other than the waste structures require El Yes IJ No ❑ NA El NE or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [llo ❑ NA ❑ NE
maintenance/improvement? ,,/
1 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LI No [JNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, ,Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C ltd W�c + `'ge—t s
13. Soil type(s) 4.1'j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0,�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-N'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Comments {refer to question #,): Exphiia any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain sitnations. (use additional pages as necessary):
ke: ��b� `x`33.33Q
Reviewer/Ins ector Name c > Sti �, a . tt Phon
P l' %� �... k s rfi,A
t o k
Reviewer/Inspector Signature: Date: !Z -/6 -zOb
Page 2 of 3 12/28104 Continued

A
Facility Number: gZ — 1/0f Date of Inspection
Required Records & Documents F/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
El<
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`? ❑ Yes
[<o
LSNo
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 o
❑ NA
EINE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3,<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ b
❑ NA
❑ NE
Other Issues /
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'J No
❑ NA
EINE
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
,�,,�
Lf 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
�,/
L, No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerhnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
El Yes
[<o
LTNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

� �jl�s �N�tvc d D1 /o y/ zoo8
Q Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
D Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t 2C +n Departure Time: l: n1 County: _ 5*4a450n/ Region: 'RAD
Farm Name: Cal-:; C. &A f lY (x ks e_ka3 Fr 1'i Fr i St%i .r4 ALrM Owner Email:
Owner Name: 131aGk R' `iW Far ""5 r+.1 -C- Phone:
Mailing Address:
Physical Address:
Facility Contact: G -ez— M042- S— Title: —1" - SQv.--. Phone No:
Onsite Representative: Grt-e_ir-U(naec_ X ;"A. Akoav-e— Integrator: /Vuv j — $F c3�.JAl
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =A
Longitude: =0=1 n=1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
® Wean to Feeder -3900
® Feeder to Finish 2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrows to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La -er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Dischames & 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.,;
,l
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ ay Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Z
b_ Did the discharge reach waters of the State'? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
i[A No
[:INA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[0 No
El Yes
[A No
❑NA
C1 NE
❑ Yes
[3 No
❑ NA
❑ NE
12/18/04 Continued

VA
14. Do the receiving crops differ from those designated in the CAWMP?
Facility Number: $Z — Z/OI I Date of Inspection
[4 No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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: _ /I& Scr+z_ Fi`Nls�c.�
❑ NA
❑ NE
Spillway?:
❑ Yes
& No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in): �� Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q� 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
[4 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
[4 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
L1 Yes
No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[NNo ❑ 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) 01ny-- K I r [�.1 5 ea "i
13. Soil type(s) L +v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vj No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
& No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name e.l S Phone: CPO, #33, 330D
Reviewer/Inspector Signature: �� Date: /2 - IZ - ZOo 7
12/28/04 Continued

-f • a
Facility Number: $Z —lkjj Date of Inspection X2-/2-07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EP 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 (20 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q 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
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
ElNA
C3NE
29.
m
Did the facility fail to properly dispose of dead animals within 24 hours and/or docuent
ElYes
[I 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
99 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[� No
❑ NA
❑ NE
Comments and/or
12/28/04

® Division of Water Quality
Facility Number I X; -.1�- �/ Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t0 <Q-D(P Arrival Ti,,,m/Ie: �O!00 Departure Time: S:aD County:�� Sa.�I Region:
Farm Name: CQS Coad e '1yu rs<_ , � )cI rWs4.h� Owner Email:
Owner Name:— Ajnr j Rive V- i v LL C Phone:
Mailing Address:
Physical Address:
"If!
Facility Contact: t -e r- r- tuna rc. Title: e� SDG C • Phone No:
Onsite Representative: �K�-t c�� Tiw, l�a0� Integrator: lllurp�a gYo�� _
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= n =. = H Longitude: I=] o = l = u
Design Current Destgn Current Design Current
Swine Capacity Populat,on Wet Poultry Capacity Population Cattle Capacity Population
❑
an to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder 2 6," ❑Non -La er ❑ Dairy Calf
Feeder to Finish❑Dairy Heifer
❑ Farrow to WeanPry Cow
s<
❑ Farrow to Feeder;'-: 'LLr '°` "'''`- ❑ Non -Dairy
❑ Farrow to Finish � ❑ Layers ❑ Beef Stocker
❑ Gilts ."-,E] Non -Layers
❑Beef Feeder
❑ Boars - ❑ Pullets
❑ Beef Brood Co
FW , ❑ Turkeys
Uther ❑ Turkey PouIts
❑ Other ❑ Other Number of Structures:
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
Q2 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[4 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
❑ Yes
M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[6 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page I of
12128/04
Continued
ate. ...�: _..�....... _.. _... _. _. e

Facility Number: 912— 4/.p
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 1
Structure 2 Structure 3
Identifier:
Spillway?: AIQ
Reviewer/Inspector Name �G _ S� - -^-----�~� Phone: rQ)R.30
Designed Freeboard (in): 19 //
Do the receiving crops differ from those designated in the CAWMP?
Observed Freeboard (in): 7-111
$No
Structure 4
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9 No ❑ NA [j NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes *o ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes [� No El NA E] NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;I No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _ 1^.oYi✓ SOt, Lo'e—, Lti� Z Jj e_k.
13.
Soil type(s) �, Al
Reviewer/Inspector Name �G _ S� - -^-----�~� Phone: rQ)R.30
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
P§No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[❑ Yes
P1 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �G _ S� - -^-----�~� Phone: rQ)R.30
ReviewerA nspector Si gnature: Date: /0—/0—Za0 _
Page 2 of 3 12/28/04 Continued

Facility Number: $Z --VO/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes [jNo []NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5YNo [INA ❑ NE
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EffNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
EINE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
P 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
P 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
C9 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time:County: rSo L Region: E9 0
Farm Name: f �aScsi Ar - x: ice. at�� Owner Email:
Owner Name: —Side_ k 94U ee CarwdJ Phone:
Mailing Address: a�& x ( L40L" s N C a kvy�
Physical Address:
Facility Contact: 6 f c•' Al oar e i .i - %on: a Title:
Onsite Representative: (), ^ee- Mc er["", mmi.. VA 0, ^
Certified Operator: .3 a r. , _ Yv 00 e
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ O =A =q Longitude: =o ❑' El u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
91tWean to Finish I I Layer
Wean to Feeder I gejo o ❑Non -Laver
Ei�feederto Finish o U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischar es & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feedcr
❑ Beef Brood Co
Number of Structures: Ell
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 3 N ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[RNo
[]NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
12128/04 Continued

w
1 '
Facility Number: kl� — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Qjll�o ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 53 o ❑ 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
❑ on ❑ Weep-fFeehearEl ❑ Wastr^Analysis ❑ Soil -Analysis ❑ Waste Transfers ❑ Annual Certification
❑ R7titifall ❑ Storicirig ❑ Cter+i,_4& ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
Eg**NI:
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
❑ NA
9 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[D' No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ej�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[JNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�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
[tNo
❑ 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
El Yes
LJ No
E(
❑ 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
D No
D/
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Adtliiional'Comments and/or Drawings: 4
12/28/04

Facility Number: — of I 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 1 Structuri, Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): r Q
Observed Freeboard (in): Z?_ C
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [D'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 [j"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? ElL1f Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[2 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Reviewer/Inspector Signature: 6 Date: L f f —a J
9. Does any part of the waste management system other than the waste structures require ❑ Yes
dNo -
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[VNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�
13. Soil type(s) LN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[Q
!� No
❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
QNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes
,[��,/No
El"No
❑ NA ❑ NE
Comnients.(refer to question #): Explain any YES answers and/or any recommendations or any other comments.:
Use drawings of facility to better ex plain situations. (use, additional pages as necessary):
Reviewer/inspector Name "�. - „F,,, T �a Phone: v0
Reviewer/Inspector Signature: 6 Date: L f f —a J
12/28/04 Continued

t
�1••'�'+'•^_..�x%,....:�:a :�...r=,.'_.:._,...:sem...-.�rW.u�.-.�»'.:i=:S^.-.....-r..:�.._.� _. s .. _�. -,,. "• .._ __ _,_.__._ -, .. ..-r_-w....• c.. ...- -. _.1�
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access I!
Date of I'isit: Time: E== 1zV 30
Facility Number d
- --. .... Not O erational 0 Below Threshold
Permitted 31certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold-
Farm Name: — _&)se 6astGole _wal'cez;t art� F,�.,�`s�/.,r AIA County: 5& FRo
OwnerName-R14 Its'✓er I aca's LL_1! Phone No: 9/li~ 5•�,�- y%„��
Mailing Address: _ p 0- do. ?r NQ(.f_& Ali_
Facility Contact: tsrevr AOvld Title: Phone No: �q(p - �
Onsite Representative: e - e- Integrator: Auee)4 r,•, /hell".l
Certified Operator: _ 124!2ei eaaeP Operator Certification Number:
Location of Farm:
I" Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C - Longitude C�0 �-
Design Current Design Current Design Current
Swine Ca acitt Population Poultry Capacity Population Cattle Ca achy Population
can to Feeder 1 34,00 10 Laver 1 ❑ Dairy
EX-eeder to Finish v ILI Non -Laver I I ID Non -Dairy
❑ Farrow to lkean
❑ Farroxv to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Solid Traps IQ No Liquid Waste Management Svstem I I _
Discharges & Stream Impacts
1. is anv discharge observed from any part of the operation? ❑ ye,❑
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharz. is observed, was the conveyance man-made? ❑ Yes �Io
b. If discharge is observed, did it reach Water of the State? (If yes, notifi• DWQ) ❑ yeso
c. if discharge is observed. what is the estimated flow in eal/min? �r
d. Does discharge bypass a lagoon system? (If v_ es: notify DWQ) ❑ Yes D<
2. Is there evidence of past discharge from any part of the operation? ❑ YL—s EK
3. Were there anv adverse impacts or potential adverse impacts to the W aters of the State other than from a discharge? ❑ Yes [R-1�0
Waste Collection 8' Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes L�fNo
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ' lljv/. F,
Freeboard (inches).-
05103107
inches):05/03/07 Continued

Facility Number: &2-- yof
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes B<O
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 2<0
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes [31�o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [1To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2116
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Er! o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [340
❑ Excessive Ponding ❑ PAN ❑ Hydraulic 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 ❑'1\lo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
0.N6
gyp'
b) Does the facility need a wettable acre determination?
❑ Yes
Q -M
c) This facility is pended for a wettable acre determination?
❑ Yes
Q-Plo
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Ig<o
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
Q'No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
O,Aio
Air Quality representative immediately.
� -
Comiaei4ts (refer to quesbon.) Expl$m guy YFS answers and/or any i�ecommendatiorns or anp_otlzer comments.
:Used Ings of fact'Lty to better expiauz sxfnations. (use ddthona! pages as necessary)-F1'e1d Co Final Notes k ,E
s u n py ❑
i
gyp'
Reviewer/hupector Name
[l� !3 rrxrtT
Reviewer/Inspector Signature:Date: -0
12112/03 Continued

Facility Number: —L, Ly Date of Inspection
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONO -
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
{ie(c Jeh<s, de ri s, etc.) ❑Yes 84d'o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9;�Wo
❑ pp cation ❑ ❑ s C 14QU� Sampliat-
1-9V,O
24. Is facility not in comp ' ce with any applicable setback criteria in effect at the time of design? ❑ Yes PN6
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes gNt
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes F5.Wo
27. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑ Yes [ANO
28. Does facility require a follow-up visit by same agency? ❑ Yes [9-140
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 21 o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
0,Y -es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®lwd
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q -Ko
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
M•N5
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
[-Ale'
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑-Stocking Form ❑ Crop Yield Form Q$ainf< ❑ Ins ction n
❑ ns ❑ Annual Gertifiee6on-Form
Q No violations or deficiencies were noted during this visit You will
receive no further correspondence about this visit.
ddittpnal Comments and/or>Drawings -_ _ - i
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12/12/03