820409_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Tiq1W Departure Time: /, 7 County: a`v Region: �1
Farm Name: PAL— Owner Email:
Owner Name: ��s FQe,�,rs _ Phone:
Mailing Address:
Physical Address:
�1
Facility Contact: JQ t-vys L.Q Title:
t[
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator: ftlo-54-m
Certification Number: V6 b Y/10
Certification Number:
Location of Farm: Latitude: Longitude:
Discharnes 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 P No ❑ NA ❑ NE
❑ Yes [:]No [P NA ❑ NE
❑ Yes [-]No {NA ❑ NE
[::]Yes ❑No
❑Yes No
E] Yes No
P NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued
'Design'
Design Current
Current
Desiga Current
Swine Ca aci Po
P tY P
Wet Pou fry
Ca' aci
P,, t}'.
Po P•
Cattle Ca aci Po .
Wean to Finish Ill
11-ayer
I
Dairy Cow
Wean to Feeder El
Non -La er
IDairy Calf
Feeder to Finish
�; �,
$.
Dai Heifer
Farrow to Wean 2-03,6
Desigu
Curren#
D Cow
Farrow to Feeder
. P.oult -
@a ac'
Po
Non -Dai
Farrow to Finish
Layers ers
Beef Stocker
Gilts
on -La ers
Beef Feeder
Boars
llets
Beef Brood Cowrke
s
er
rke PoultsOther
her
Discharnes 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 P No ❑ NA ❑ NE
❑ Yes [:]No [P NA ❑ NE
❑ Yes [-]No {NA ❑ NE
[::]Yes ❑No
❑Yes No
E] Yes No
P NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ElYes?NoNA�h] ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure" 6
Identifier: `1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� 1!y u
5- Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA p NE
(i.e., large trees, severe erosion, seepage, etc.) 9
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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste A006eation
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 0 Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
/1 �„ r 6
13. Soil Type(s): {"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 ❑ YesNo ❑ NA [:]NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes 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 F No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes � No
❑ NA
❑ NE
Page 2 of 3 214/2015 Continued

on A
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes q3No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cp No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ YesNo
❑ Yes 9No
❑ Yes No
❑ Yes No
❑ Yes No
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
rA
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or':any other°comatents�-AFP .l j
Use drawings of facility to better explain situations -(use additional pages as necessary). f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

type of visit: ® compliance inspection v tiperatnon Keview U structure Evaivatton V tecnmcai assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q' Departure Time: Coun eWRegionr/"-
Farm Name: �� % Owner Email:
Owner Name: �t Phone:
Mailing Address:
Physical Address:
Facility Contact: crag.� Title: Phone:
v
Onsite Representative: ��integrator:
%, ' y�J
Certified Operator: e L Rolao-- Certification Number: 7 ��
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Ml
Design Current Design Currentt Current
Swine Capacity_ Pop. WetFPoultry Capacity PopW Cattle Capacity Pop,
Wean to Finish Layer Y
Dairy Cow
Wean to Feeder Non -Layer Dairy Calf
Feeder to Finish ,� Dairy Heifer
Farrow to Wean 770 14Design Current Dry Cow
Farrow to Feeder Doult . Ea aci ,.Po Nan -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers 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 ''� No [3 NA ❑ NE
[:]Yes [] No
❑ Yes [:]No
M
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes
[:]No
® NA
�❑`
ED 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 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesNo
[P No
❑ NA
❑ NE
a. 1f yes, is waste level into the structural freeboard?
❑ Yes
No
NA
❑ NE
Struc e I Structure 2 Structure 3 Structure 4
Structure 5
1W
Structure 6
❑ NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
Designed Freeboard (in):
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
Observed Freeboard (in):
Required Records & Documents
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.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
i
U0 No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
�3 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
S. 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
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA DIVE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Win Drift ❑ Application Outside of Approved Area
W, / �<, �2�� &,I
12. Crop Type(s): i. O � S
13. Soil Type(s): LQ.Ei
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ 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
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
U0 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. ❑ YesNo
❑ Waste Application ElWeekly Freeboard [:3Waste Analysis ❑ Soil Analysis ❑ Waste T nsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of Inspection: Itj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
[] Yes
No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
permit? (i.e., discharge, freeboard problems, over -application)
25. 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
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on-site representative?
❑ Yes
M No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
()n No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ NA
❑ NE
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on-site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[M No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: e?1 O --t(3 3-73 00
Date:4/70/-7
2/4/2015

Type of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Q Follow-up () Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: /Z� Departure Time: r}�?�� County: .r
`— I
Farm Name: P- ` Owner Email:
Owner Name: pw_�f_ +mss Phone:
Mailing Address:
Physical Address:
Region: IWO
Facility Contact: L3 a n--eS L 11L Title: Phone:
Onsite Representative: ti Integrator: Q'�P_94_9c
Certified Operator: Al Q n A'40'r- Certification Number: 9.9(0 Y 16
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Vet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
2PPO Zt77,0
Design
Curreat
Cow
Farrow to Feeder
D . P,o_nitr
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
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 DWR)
❑ Yes F No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [] No
NA ❑ NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters C] Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facility Number: q IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39 --- e
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
P No [3 NA ❑ NE
❑ No 51 NA ❑ NE
Structure 6
❑ Yes tj] No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EP No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes in No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2FVo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window r❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): 3�C'wu,dLa ?l -rq sS}� Si+-• is=rte �^
13. Soil Type(s)
}r
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes W No ❑ NA ❑ NE
❑Yes [PNo ❑NA ❑NE
❑ Yes P No DNA ❑ NE
[:]Yes [�) No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Pg 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 P] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

FaciliNumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 10 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J8 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a AOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Yes f!!� No ❑ NA ❑ NE
❑ Yes
No
❑ Yes
No
[:]Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers andlor-any additional recommendations-.ora�ny�othei �tomments:
et
Use drawings of facility to beaker explain situations use additional pages as necessa
( P g ry) :: E r .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U 'Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Q t County• Region: L
Farm Name: Owner Email:
Owner Name: 0. (Yl Phone:
Mailing Address:
Physical Address:
Facility Contact:
S __I'1f1 Title:
Onsite Representative:
Certified Operator: _ Z l__fCJ�L_a s....
Phone:
Integrator:
Certification Number: 196 YA
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
JLayer
Dairy Cow
Wean to Feeder
I INon-Lyer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design .Current
Dry Cow
Farrow to Feeder
D . P.oat
Ca aci
P,o
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow Ell
Turkeys
-
011ier -
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ED No ❑ NA ❑ NE
❑ Yes
❑ No
eq NA
[] NE
❑ Yes
❑ No
[P NA
❑ NE
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
❑ Yes 19 No
❑ Yes E3 No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

jFacility Number: - Date of inspection: /
❑ Yes
Q No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Q No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® 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:_
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ NA
Spillway?:
Re uired Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�j No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z? 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
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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q 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
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3 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 4g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,[ No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili iNumber:- Date of Inspection: I V1 IM
1
rM No
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
Comments (ref er to question #) Explain any YES answers:and/or any: additional recommendations oe,any other comments:
❑ 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
[ /UNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Eg 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?
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 F? No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
rM 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 (ref er to question #) Explain any YES answers:and/or any: additional recommendations oe,any other comments:
_ ', , � � , _T �- , . x r, ..twu
Use drawings of:facility to better'explain situahons.:(use additional pales as necessary}:
..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
211120;4

type of visit: qp c;ompuance inspection V uperanon Keview V btructure Evalu anon V iecnmcal Assistance
Reason for Visit: *Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Timez p County: Region:Date of Visit:
Farm Name: Owner Email:
Owner Name: t,T.5��-+C� Phone:
Mailing Address:
Physical Address:
Phone:
Integrator: �R°S
Certification Number: '1'7 -/
Certification Number: 7 bb _
Location of Farm: Latitude: Longitude:
1
�
Facility Contact: 12ah14
RO_ Title:
Current
Pop.
Onsite Representative:
L1'ti'k+J
Certified Operator:
D . P,o_ultr
Design
Ga aci
Current
Po P.
airy Calf
airy Heifer
lDrvCow
Non-Daify
Back-up Operator:(�N
Feeder to Finish
Farrow to Wean
Phone:
Integrator: �R°S
Certification Number: '1'7 -/
Certification Number: 7 bb _
Location of Farm: Latitude: Longitude:
Discharges and Stream ImUBets
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 D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes }(' No [:]NA [—]NE
❑ Yes
Design Curren#
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
NA
Wean to Feeder
D . P,o_ultr
Design
Ga aci
Current
Po P.
airy Calf
airy Heifer
lDrvCow
Non-Daify
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars I
Other
Other
I.Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream ImUBets
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 D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes }(' No [:]NA [—]NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
❑No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 2/4/1011 Continued

Facili Number: Date of Inspection: 2129ILL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: j^115
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): N ��
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑NA
❑ No 170a
Structure 6
[]Yes r" No ❑ NA
❑ NE
❑ NE
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
M No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C" �-5 �/lt Gvzt4li
13. Soil Type(s): Czxg
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes] No ❑ NA ❑ NE
acres determination?
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes` No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily'availabie? ❑ 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. T
[]WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes §g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

IFacili Number: -19,71 Date of Inspection: !211,W&-
()j No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
1P No
❑ NA
❑ NE
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
1 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
()j No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ 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:
2/4/2011

Itype of visit: qpuompuance inspection V uperanon xeview V structure Evaluation V I ecnnical Assistance
Reason for Visit: 4DRoutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: -00jDeparture Time: ps�f jj�;J .County:
Farm Name: P-4 Owner Email:
Owner Name:TS� �QNyns + Phone:
_. :
Mailing Address:
Physical Address:
Region:4
Facility Contact: 'p.1.j �� Title: Phone:
Onsite Representative: Ta n1Qs 64 Integrator: Tiy4vae
Certified Operator: Certification Number: 177%
7%
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design "C went Design Cur er nt
Capacity Pap WetPoultry _ Cap citV"^Pop
Layer
Design Current
CattleMENUmmy Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
l°,* Design=Current
Dairy Heifer
Dry Cow
Farrow to Feeder
* sD l'oult w
Ca ac�ty �Po
Non-DaIty
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
°
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
I'MOther Turkey Poults
Other
jOther
Discharees and Stream lmoacts
1. Is any discharge observed from any part of the operation? [-]Yes QqNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 rO No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [P No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Faeffi Number: Ig - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA E] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No M NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: & a
Spillway?:
❑ Yes
No
Designed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in): .36 Y
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes `P No
[:]NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes `rVD t' No
[DNA
❑ NE
waste management or closure plan?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require ❑ Yes [� No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[P No
Waste Application
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R] No
❑ NA
❑ NE
maintenance or improvement?
❑ Sludge Survey
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ NA
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Page 2 of 3
12. Crop Type(s): C2q�w &�ryYt'l "S�66"1) Sf1. /�,- Wn IijP'4"ea
2/4/2011 Continued
r
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 ® 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
5 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�j 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
[P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facial Number: jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EP No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes �S 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes g] No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
P0 No
❑NA
❑NE
®No
❑NA
❑NE
® No
❑ 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 (ase additional naves as necessarv).
Res ff'�-c/i �,►c.� �j .i! �'l J�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: +
214/2011

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: a { Q Arrival Time: Departure Time: / ` County: Region:
Farm Name: Owner Email:
Owner Name: C' G G Phone:
Mailing Address:
Physical Address:
Facility Contact: (- Title: Phone No:
Onsite Representative:C..�- �.4 v�•6 Integrator: # �C✓�}'�-
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =0 =I = " Longitude: 0 o ='
=
J
Design Current
Design Current
Design Current
Swine C►apacity Population
Wet Poultry Capacity Population
Cattle Capacity Popuian
❑ Wean to Finish
❑ Layer
❑ Yes
❑ No
iry Cow
❑ Wean to Feeder
❑Non -La er
V No
❑ NA
iry Calf j
❑ Feeder to Finish
$�DNo
r�
iry Heifer
Farrow to Wean 2 Cop
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
❑ Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ 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 PNo ❑ NA EINE
❑ Yes
❑ No
91 NA
❑ NE
❑ Yes
❑ No
IRNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
$�DNo
❑ NA
EINE
Page I of 3 12/28/04 Continued

r
ti
4
Facility Number: Date of Inspection 1?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No eo NA ❑ NE
Structu e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the intelp ity of any of the structures observed? ❑ YesNo [:1NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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 9bNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes�No F-1NA❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of( Acceptable Crop Window
n❑ Evidence
of AJ,
Drift ❑ Application Outside of Area
12. Crop type(s) � 4to &fro- 61 1� � [!'JQJ , ✓x/4 , (1 00V_x l
13.
, -
Soil type(s) cab
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
MbNo
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
1� No
❑ NA
❑ 'NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
(8 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
[)d No
❑ NA
❑ NE
Tis ajC&,-,1 91/Za1,a,
Reviewer/inspector Name Phone: �O' 33'3�CaD
Reviewer/Inspector Signature: Q� Date: c t7
Page 2 of 3
12/28/04 Continued

• Facility Number: Date of Inspection `
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
FO
tP NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RR 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
Y, No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MI No
❑ NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 72/28/04

r
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: (.b /w Departure Time: Q2: odQ County: -"� C Region:
Farm Name:
Owner Email:
Owner Name: S "l;Z& - Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�YY1i�4 LSu
Certified Operator: Tqnjm
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: r + r L SD—
Back-up Certification Number:
Location of Farm: Latitude: = o ="
Longitude: = ° = I =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
n Current
❑ NA
ulation
NO,
Cattle Cy Popu
apacitlation
❑ Wean to FinishI
ID Layer
1
❑ Dairy Cow
❑ NoNA
❑ Wean to Feeder
[__1NE
❑ Non -Layer
I
❑ Dairy Calf
9NA
❑ Feeder to Finish
I I
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
2_ Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
-
❑ Turkeys
other than from a discharge?
Othe 221❑
❑ Other
Turkey Poults
10 Other
Number of Structures:
12128/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�ONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ NoNA
[__1NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[IYes
❑ No
9NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
gNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LN
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

,r
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No�NA El NE
Stntcture I Stnicture 2 Structure ? Structure .1 Structure 5 lructure G
Identifier:
Spillway',.-
Designed
pillway`?:Designed Freeboard (in):
RA
u
Observed Freeboard (in): PTV
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes NA No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
70 No
❑ NA ElNE
through a waste management or closure plan?
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo
No
r�
ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
01 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1A No
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect 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 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)
13. Soil type(s) Ut4k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
193 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
�INo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
r�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Q Phone: -3
Reviewer/Inspector Signature: A Date:
' - / / 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes toNo ❑ 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.
❑ WiJP ❑ Checklists El Design El Maps [:1 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 I " Main Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
[INA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
U9 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
leNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
T No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1� No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1PNo
❑ 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
bNo
❑ 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
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ No
❑ NA
❑ NE
12/28/04

.4
1�_���E7:6��qIIII 0 Division of Water Quality
IF 1ifyity Number = Q Division of soil and Water Conservation
Q Qtlter Agency
4
-11
Type of Visit *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: %f Departure Time: 1 County:
Farm Name: Ll Owner Email:
flwnPr Names- s -- phnnn•
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L%1'1�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator ���g
Operator Certification Number:
Back-up Certification Number:
Region: PIQO
Latitude: = o =I =" Longitude: =0=1 0 "
Design Current
= Design Current
Design Current
Swine Capacity Population
«'et Poultry °Cape i�ty�Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ No
❑ Wean to Feeder
❑Non -La er
Dry Poultry
❑ La ers
❑Dai Calf
Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Feeder to Finish
Farrow to Wean t3
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -La ers
❑ Pullets
❑ Beef Feeder
❑Reef Brood Cow,
❑ Boars
❑ Turkeys
Qtl
[]Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream lmpacts
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 rt"jNo [INA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
)N)NA
❑ NE
❑ Yes
PbNo
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

4
❑ Yes
rNo
15. Does the receiving crop and/or land application site need improvement?
e Facility Number: Date of Inspection
19 No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? [l Yes
KNo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 'Po
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
9 NA
❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3aii
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Wo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes �9No
❑ 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ANo ❑ 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 ViNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes MNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JO 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) �S-W &r GYMS S *) f —Sm, {{h badad
13. Soil type(s) C14�y' txg_-_4_r Cab
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rNo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
19 No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? [l Yes
KNo
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�En
L7 No
❑NA [:1 NE
❑ NA ❑ NE
E] NA 0 N
0 N ❑NE
❑ NA ❑ NE
. `� ty p L ecommeadations or any.ather comments.
Comments {refer toqueshon #Exp any YES�answersan�or any r
Use drEWlll of fatda to better ex lam sltnahons. {nse aitdtttonal pages 8s necessary):
Review erllnspectar Name - — — - Phone: 3r.Ob
Reviewerllnspector Signature: Date:
Page 2 of 3 12/28/04 Continued

.-
s
Facility Number: — Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑Other
❑ Yes
F No
ElNA
❑ NE
ElYes
[LNo
❑ NA
❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 49 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[6 No
❑ NA
❑ NE
❑ Yes
09 No
❑ NA
❑ NE
❑ Yes
K) No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes P9 No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 99 No ❑ NA ❑ NE
❑ Yes �dNo ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
12/28/04

i
.. 1
Division of Nater Quality
Facility Number - 0 Division of Soil and Water Conservation
_.- -- 0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assis=Access
❑ Yes
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denie
Date of Visit: 5 Arrival Time: Departure Time: i tQ0 County: Region:
Farm Name: ' Owner Email:
Owner Name- Phone:
Mailing Address:
Physical Address:
Facility Contact: ��-� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
,Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other T
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = O ='
=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�' ❑
Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream lmpacts
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 Heifei
CTDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
IF NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection S a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IR NA ❑ NE
St re 1 S e e l Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Ep No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes K73 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes®
No
T
El NA El NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
[--INA ElNE
El Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
\
❑ PAN ❑ PAN > 10% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
/Crop
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
[INA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
�RNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�LNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Q j K)Q)LJ it Phone: Y 3
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2$Vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes1�No ❑ NA [3NE
the appropirate box.
ElWUP ❑Checklists ❑Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ElNA E]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 rp 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
;B No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[, No
lUNo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:1 Yes
_
❑ NA
❑ NE
Other Issues
[
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[)JNo
❑ 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
4No
❑ 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
[5 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
11No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit Q5rCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: iaeh6j r Arrival Time: Departure Time: Ft.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:D( Title:
Onsite Representative: RQ, �
Certified Operator:
Back-up Operator:
County: So r1 Region: F;0-0
Owner Email:
Phone:
Phone No:
Integrator: Py -es "'L t _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =, = Longitude: = ° [--]1 = u
Dischart~es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Cs DesigpCurrentesgn
CurrentA'Sw
❑ NE
1sign
6!aepacity
Population Wet Pou t-7' ap�ac ty�Popnlat*on
Cattle C►specify Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
[SNA
❑Non La er
❑Dai Calf
❑ Feeder to Finish,
❑ No
[JNA
❑ Dai Heifer
Farrow to Wean
ZCCD
oZB b$ Dray Po try � y
❑ D Cow
❑ Farrow to Feeder
❑ No
El Non -Dairy
❑ Farrow to Finish
❑ Yes
❑ Layers
❑ Beef Stocker
Gilts
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElNon-Layers
❑Beef Feeder
P_1Boars
❑ NE
El Pullets
❑Beef Brood Co
❑ Turkeys
Page I of 3
Other
Other
Continued
' ❑ Turke Poults
❑Other
Number of.5tructures: ��
Dischart~es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
[--INA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[SNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[JNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
®NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[]�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2/No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility ]Number: Date of Inspection
1
Waste Collection & Treatment «-7 �� C6
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 U.1 1 7 ❑ NE
St ture 1 Stru ture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): J q r�rjj
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EltVo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
`Y "o ❑ NA
EINE
through a waste management or closure plan?
Reviewer/Inspector Signature: ILI AAA,, Date:
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
ONo [INA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesrNo
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
El Yes
❑ NA
❑ NE
maintenance or improvement?
,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QhNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce�prtaaabfflerr Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) V ht , SAW)
13. Soil type(s) U�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [h 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 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes (&No ❑ NA ❑ NE
Comments (refer to question #): Explain anv YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name Phone. tito433 -33ot�
Reviewer/Inspector Signature: ILI AAA,, Date:
Page 2 of -3
��12/28/04 Continued
0 (�

FAciUty Number: g`,— qOR I Date of Inspection f0
Required Records & Documents "M/O/,
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
[__1 Yes 'J�No El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�j No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [R 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 `fes "No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `Vlo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ 9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(,P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
i No
❑ NA
❑ NE
Other Issues
❑ Yes
[P No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? Cl Yes Q§ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P 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
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
�] No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9No
Iff
❑ NA
ElNE
Additional C©Enineuts and/or Drawings:' ' ` V.
r
Page 3 of 3 12/28/04

C
Type o€ Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Scv*.o._3ar4
Farm Name: P — _ _ _... Owner Email:
Owner Name: Pr r S �—� 4 — _Fa v r•-, s _ _ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: V2,ar e -Caoo A-_.
Certified Operator: f3 cY <_Xoc>
Back-up Operator:
Location of Farm:
Phone No:
Region: rW
Integrator: Pr e- a 9
Operator Certification Number: / 7 7Fc
Back-up Certification Number:
Latitude: =0 =1
Longitude: =0=1
o=1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish l ❑ La er i
r
❑ Wean to Feeder ❑Non -Lave
❑ Feeder to Finish
❑ Farrow to Wean 9,000 o2,107
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current..'.
Cattle Capacity Population .
❑ Dairy Cow
❑
Dairy Calf i
i
❑
Dairy Heifer i
❑ Dry Cow I
❑ Non -Dairy!
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[:1 NE
[-I Yes
El No
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
m No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 02- yo 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;l Structure 2 Structure 3 Structure 4
Identifier: 4��r_
Spillway?:
Designed Freeboard (in). »f 19 ".7
Observed Freeboard (in): cg -J_7
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 [R No ❑ NA EINE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any 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 UNo ❑ 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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Qer m ,.J, LL41 D.S
13. Soil type(s) (_,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© No
❑ NA
❑ NE
` COA,4I hu e- 4-C. W 0
44c- '-APOLi 4 O AA 1
ON Q,s-�tS l,s�- in� �. �%�5 �,-Fc��uc GQ✓CK_ G.[a
N fig
Reviewer/[nspector Name-� K Phone:
Reviewer/inspector Signature: Date: Y—P71GS
11/28/04 Continued

Facility Number: ,?— yvF Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box.
❑ WUF El Checklists El Design E] Maps [:1 Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
@ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours andlor document
❑ Yes
y 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
[21 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
�0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerA n spector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Addi Tonal Comments andlor�Drawings:. _ . u z �'- z � 1
12/28/04
12/28/04

4.
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
for Visit 9 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Numberer
Date of Visit: 3- 9_a Time: r==
d
Q Not Operational Q Below Threshold
El*e"rmitted MCertified.
�JDlC/onditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: ...................... ! -_--1 .........................._ ....•....._ - ........._ .___ . County:
Owner Name:.. Pres44Isar... S Phone No: _....------W._.
'Mailing Address:.. BOY,_. Z/
3 - ...—. C�, �� �Y .. • S3r'?
Facility Contact: __. 17Jr ........ 969.&A._ .................. Title:.. - _ . Phone No:
Onsite Representative:. --&c Integrator:...
Certified Operator: ,,•,,,,,,) Oaf/f� --Al--dare Fo�� Operator Certification Number: �7 � ��
Location of Farm:
ice- Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • & 44 Longitude • 6 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ yes GjWo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsmed, was the conveyance man-made'? ❑ Yes 050
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes [3 -No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes D -Ko -
2. Is there evidence of past discharge from any part of the operation? ❑ Yes G�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G -Nb
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes D.Xo-
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ......... _.A----------------- ... --........ 1. ... ............. ........................ _.......... _......._ .......
Freeboard (inches): '2 Lq
12112103 Continued

I IFacility Number: g.7 — Lyol
Date of Inspection - e y
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste APRlic3tiOn
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ Yes ❑-Iqo-
❑ Yes n<6
❑ Yes &No
❑ Yes D -bio
❑ Yes ❑-1Qo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes &-No
❑ Excessive Ponding/ ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C,jal
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW T)? ❑ Yes ❑-No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [s- -foo
❑ Yes thio
❑ Yes �o
❑ Yes [aVo
❑ Yes G -K
❑ Yes [9,Mo
❑ Yes [9�No
❑ Yes Ea -mo
❑ Yes UNo
Comments refer to question`#} Ex plain any' YES a �srveis and/or any; �ec mmendations or any. other comments. t
_ _. .. _
'Use drawings of lefty to' better explmrn sittamtaons. (use#�anal pages as necessary) ' field Copy [3 Final Notes -
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Reviewer/Inspector Name : I
Reviewer/Inspector Signature:Date:
12112103 f Continued

t Facility Number: Y2 — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes P -N-0
❑ Yes EM
❑ Yes 1iNo
❑ Yes EWO
❑ Yes ❑-P�o
❑ Yes M -K
❑ Yes ❑-No
❑ Yes [9 -No
❑ Yes ❑c -Ko
0,7res ❑ No
❑ Yes &No
❑ Yes O -No-
[-Yes ❑ No
0 -Ye -s ❑ No
❑ Yes 0-N10—
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
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