820411_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental W6

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: *Routine O Complaint O Follow-up O Referral 0 Emergency Q Other Q Denied Access
Date of Visit:
Arrival Time: t O
Departure Time: County:
ss1 Region:
r
c. What is the estimated volume that reached waters of the State (gallons)?
Farm Name: ! Owner Email:
Owner Name: �� t ���I'1S Phone:
Mailing Address:
Physical Address:
Facility Contact: 1LtiYyQS La" Title:
N
Onsite Representative:
Certified Operator: _ /-W Ileo vim+'+ Q V,
Back-up Operator:
Location of Farm:
Phone:
Integrator: Pre's
Certification Number:b I ��
Certification Number:
Latitude: Longitude:
DischaEges and Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes qNo ❑ NA ❑ NE
Discharge originated at: E) Structure ❑ Application Field F-1 Other:
T
a. Was the conveyance man-made? ❑ Yes ❑ No 4
NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
DesignCurrent
Design
Current
y
❑ No
Design Current
Swine Capacity Pop.
Wet Poultry
Capacify
Pop.
❑ NA
Cattle Capacity Pap.
Wean to Finish
La er
No
❑ NA
❑ NE
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish 2pGo
a
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder i.:
D 1'ou!# . ,
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t?ther
Turkey Poults
Other
Other
- � -
DischaEges and Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes qNo ❑ NA ❑ NE
Discharge originated at: E) Structure ❑ Application Field F-1 Other:
T
a. Was the conveyance man-made? ❑ Yes ❑ No 4
NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Number: - Date of Inspection: 47 Mllel
Waste Collection & Treatment
�4. Is stKage 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
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
F
PNo ❑ NA ❑ NE
❑ No P33NA ❑ NE
Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 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) 7�`�
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo ❑ NA [:]NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
be 96. E *11
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
[� 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 ❑ I -ease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 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 �l No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facilitv Number: 9 - u DDa-te of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
(P No
❑ NA ❑ NE
the appropriate box(es) below.
No
T
❑ NE
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
® No
❑ NA
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA E]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
T—'
[P No
❑ NA ❑ NE
Other Issues
2$_ 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?
f 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?
El Yes
No
[P
0 N
❑N
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Yes No
❑ Yes No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
ComFnents (refe�fto gaeidbii #): Explain any YES answers and/or any:additional recommendations or'any other oommints. :r
Use drawings of faciirty to�better explain srtuateflns.(ose additionallpages
as -necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 1 jQ _ 3?— 3 3 oU
Date:
2/4/2015

Type of visit: IV Compliance inspection V operation Review f } Structure Evaluation V 'fcchnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Design Current
Arrival Time:
Departure Time: / County:
Farm Name:
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Owner Email:
Pop.et Poultry
Capacity
Owner Name:
Cattle Capacity Pop.
Lre s
i�'� S
Phone:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Mailing Address:
Physical Address:
Facility Contact: r`�QS �J Title:
Onsite Representative: k
Certified Operator: DVS
44'4,,—
Back-up Operator:
Location of Farm:
Latitude:
Regio
Phone:
integrator:
Certification Number: 996 f [/ 1h
Certification Number:
Longitude:
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
Design Current
Design
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Pop.et Poultry
Capacity
Inent
P*:
Cattle Capacity Pop.
❑ No
Finish
Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Dai Caw
P NA
Feeder
RNIon-Layer
Dai Calf
o Finish
aS
>PoulCa
Design
aci
�.
Current x
I'o
Dai Heifer
Cow
-Dairyto
SA to Wean.
rFazTow
❑ Yes
to Feeder�"13
Finish
❑ NE
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults-
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
§g No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
F1 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P 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
tg�] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

i
Facility Number: iDate 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? [-]Yes rNo P NA ❑ NE
Structure I Stru re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes VNo ❑ 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 ❑ YesNo ❑ NA ❑ NE
waste management or closure plan? Pa
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 structures lack adequate markers as required by the permit? ❑ Yes E3 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 AnUlieation
10. Are there any required buffers, setbacks, or compliance altematives that need [:]Yes MNo ❑ 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 Acce table Crop Window f,Ev�idence indn Application Outside of Appr ved AArrea� -
12. Crop Type(s):l `-` 'jam / , • Vwttt^ V �l�'
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
❑ YesNo
LP
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ 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 E�bNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
0 N ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [3 Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P@ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question #). Explaiwany YES answers and/or any additional=recommendations o&ny.ottier comments.
Use drawings of facility to better. explain. situations {use additional pales as necessary).
Reviewer/Inspector Name:
Revi ewer/] nspector Signature:
Page 3 of 3
Phone:
Date:
2/412011

i ype of visit: 1p c:ompnance inspection V uperation tceview V structure r:vatuation V I ectintcat Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: D X00 Departure Time: ; County: ,$
Farm Name: 4 Owner Email:
Owner Name: "Py fr�. s Phone:
Mailing Address:
Physical Address:
Facility Contact: LTitle:
tf
Onsite Representative:
Certified Operator: '4—Ice k joc_Ac' "''�
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator: Axr, 4g _
Certification Number: ( 96 qV6
Certification Number:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No [:INA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
.Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I INon-Layer
I
I
jDairyCalf
Feeder to Finish
v
D , iP,oul
I Layers
P , ..`
DesignZ Current
Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean 2ADD
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other' �
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No [:INA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Faciitty Number: q
Date of Ins ection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�] No 0 NA 0 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "No [:]NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
T_
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
® NA
❑ NE
maintenance or improvement?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
'ice No
❑ NA
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 M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [D Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crap Window /❑ Evidence ofWind Drift E] Application
�Outside of Approved Area
12. Crop Type(s): 0,,54J � C} , 0,,)j �5 . • � Ute, ! a-,-, --
13. Soil Type(s): 60-M
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [n 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 P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[M 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 ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
M No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[X] No
0 NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
'ice No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Fac' ' Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit tr ❑ Yes �] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes F] 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.
34, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes V] No ❑ NA ❑ NE
[D Yes 171 No E] NA [—]NE
❑ Yes 'y""N No ❑ NA ❑ NE
❑ Yes q No
❑ Yes � No
❑ Yes q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
2/4/2014

1 ype of visit: 1p uompliance lnspernon V uperanon Keview V structure Evaluation U I edInical Asststance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: moi( f Departure Time: CountyG�_ Region: Ceo
Farm Name:— Owner Email:
Owner Name Phone:
Mailing Address:
Physical Address:
Facility Contact: Lr,-,c� Title: Phone:
Onsite Representative: Integrator:{G
Certified Operator: Certification Number:
e
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design r Current
Capacity ... Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop,
Design Current
Cattle Capacity PoP.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
3
D . P,oul
Design
Ca aci
Current
Pio
Dai Heifer
Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
OtherI
-
Turke s
ITurkeyPoults
IFTOther I I 10ther
Discharses and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZpNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Ej 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 E§ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ejj No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412014 Continued

acili Number: - Date of Inspection:
❑ Yes
,® No
[DNA
Waste Collection & Treatment
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.H No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E) No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure
5 Structure 6
[DNA
Identifier: 'T��
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,E] No
Spillway?:
❑ NE
the appropriate box.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes KI 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 R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,[+j 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
Evidence of Wind Drift ❑ Application Outside
❑ Outside of Acceptable Crop Window,,
of Approved Area
�❑
12. Crop Type(s): "11 1 f�1l N rQ�-���QS S (*''�-tel ) � Sm 6 a(n
dEn3aad,
C wr)
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Eg 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
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.H No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,E] No
[DNA
❑ 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 45 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 In No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R1 No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes CgNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rl--b No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments. (refer to question.#): Explain_ any YES a
Use drawings of facility to better eanlain situations
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
�D No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [ No
❑ Yes No
❑ Yes No
additional recommendstions or any other c4
es as necessary): _
E] NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 91 Et+Oj 190
Date: {
AA 1,14
2/ /l o 4

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: .z i d Departure Time: O/;ap f County:
Farm Name: Owner Email:
Owner Name: 'Pre S -6p.. ?YtS Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: &r& gx'�e4x'� Title: Phone:
Onsite Representative: -J( rY s L-Unyb Integrator:
Certified Operator; 12""._F� Certification Number: 17796
Back-up Operator: Y_42� Certification Number: r R1 ff 1,6
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes X No ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
Design
CurrentDesign
❑ NE
Current
Design Current
Swine Capacity
Pop.
WettP,oul#ry
Capactty Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
I
Dairy Cow
Wean to Feeder
I JNon-LayeT
I
Dairy Calf
Feeder to Finish
W �
..,-i
Dairy Heifer
Farrow to Wean
2-061
UR.
es ign Current
Dry Cow
Farrow to Feeder
D... Poul
C.aaci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Un-
owTurke
Turkeys
s
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes X No ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[--]Yes
❑No
JR NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 214/2011 Continued

Facili • Number: R5 - W7 Cl jDate of Inspection: Z$ L
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 jg NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: K—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 Q 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 J,8 No [3 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V] 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA [:]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window f❑_E�vidA:)'
cc ofWindDrift /❑� Application Outside of Approved Area
12. Crop Type(s): S C�'�-.�L 0'�
13. Soil Type(s):
� r
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?
IT 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
53 No
❑ NA
❑ WE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M 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 ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes §a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ff No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued
0

Facilit y Number: - Date of Inspection: Lg Z
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 rrl:l No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes / No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
[ No
❑ NA
❑ NE
[:]Yes
[�( No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
Phone: 910-13 "33�0
Date:Z�IL
21412011

Type of Visit: IV Compliance Inspection V Operation Review U Structure Evaluation U Ieehnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I__l.� r r i Arrival Time: Departure Time: S,f7 County:
Farm Name: P-71 Owner Email:
Owner Name: 'Pry-g7bCW _f -A- Phone:
Mailing Address:
Region: Aae
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �Qr S b Integrator: V(2 ei.e
Certified Operator: Certification Number: '`7gg6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1� No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [—]No
WA ❑ NE
NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 2/412011 Continued
,
Design
Current
Design Cur rent
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity Prop.
Eattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
t
Current
g b
D Cow
Farrow to Feeder
D . P.oult ,
p Po
Cie ac o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1� No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [—]No
WA ❑ NE
NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facili Number: jDate of Inspection: .�
i
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: 6—
N No ❑ NA ❑ NE
[:] No 19 NA ❑ NE
Structure 6
Spillway?: Spillway?:
❑ Yes
[P No
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
No
❑ NA
❑ NE
Observed Freeboard (in):
T
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
No
❑ NA
❑ NE
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?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
EPNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fp No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
52 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 ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. E] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
,� ❑ Evidence of Wind Driftft ❑ Application Outside of Approved Area
12. Crop Type(s): C�� Y�" "'ttQ G12Zs-i / !i �=Cr#4 ►'1
13. Soil Type(s): _ct_J
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 [ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? TT
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
❑ Yes No
❑ NA 0 NE
❑ NA [] NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P 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
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
[DNA
❑ NE
Page 2 of 3 214/2011 Continued

Ff'ciliNumber: Date of Inspection:
2�. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 ReviewerlInspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
❑ Yes 6 No
[:]Yes ❑ No
❑NA ONE
Ug NA ❑ NE
❑ Yes �j No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
CZ No
❑ NA
❑ NE
Phone:
Date:
2/4/2011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f� f _ Arrival Time: Departure Time: Z' -DJ County: != _e4A) Region: F961
Farm Name:
Owner Name:
Mailing Address:
Physical Address
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: TowKi5 La* -.J Integrator: r N5fie
Certified Operator: Operator Certification Number: ' r
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e =1
❑ Longitude: = ° = I = u
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 r"J No ❑ NA ❑ NE
El Yes
❑ No
[p NA
EINE
Design Current
Design Current
Design Current
EINE
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Fl:—]Wean to Finish
JE1 Layer I
❑ Yes
❑Dai Cow
❑ Yes
❑ Wean to Feeder
ILI Non -Layer I
❑ NE
Calf
NNo
❑ Feeder to Finish
❑ NE
❑ Dairy Heifer
Farrow to Wean OL�0
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Dumber of Structures:
ther
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 r"J No ❑ NA ❑ NE
El Yes
❑ No
[p NA
EINE
❑ Yes
❑ No
§j NA
EINE
PNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: Date of Inspection
❑ Yes
SNo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑'No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
P7NA
❑ NE
Struc re I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ YesLA
No
Spillway?:
ElNE
Designed Freeboard (in):
Observed Freeboard (in): 2) 9rt 3 t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes 'No
ElNA
ElNE
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 ff NNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '_-1
No ❑ NA (]NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ctq,Stt�.( & �g aA &V' 4%t ow wd 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
SNo
❑ 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
[)I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesLA
No
ElNA
ElNE
12F-co,rdS y'e/t`tj `f Z410
IReviewer/Inspector Name WW !?! A,V�Q' Phone:
Reviewer/Inspector Signature: Date: tp
Page 2 of 3
12/28/04 Continued

1 �
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P 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 p ❑ Other
21. Does record keeping need improvement? I f yes, check the appropriate box below_ ❑ Yes No ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P 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
1p No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(l No
❑ NA EINE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'p No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
% No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Py No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�l No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Ep No
❑ NA ❑ NE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: r
Arrival Time: ` Departure Time: County: ���/" Region: !"I«
Owner Email:
Owner Name: ��STQC��—-�� S JG Phone:
Mailing Address:
Physical Address: QQ
Facility Contact: i1 i]Q.r Title: Phone No:
Onsite Representative: J YJ Integrator:
Certified Operator: Operator Certification Number: 17796
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0
=d
=is Longitude: =0=s
o❑s = ae
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tNo
[
Design Current
Design Current
rr
Design Cuent
Swine Capacity Population
Wet Poultry Capacity opulation
P
CattleCapacityPopulation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
[PNA
10 Non -Layer L I
❑ Dairy Calf
❑ Feeder to Finish
❑ No
bm
1 NA
❑ Dairy Heifer
Farrow to Wean g
Dry Poaltry
❑ Dry Cow
❑ Farrow to Feeder❑
Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turke s
ip No
Other
❑ Turkey Poults
Nutnber of Structures:
❑ Other
❑ Other
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tNo
[
(:INA
[INE
Discharge originated at: [I Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[PNA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
bm
1 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
V] No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ip No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

tr
Facility Number: A,�,—Jj Date of lnspeetion
❑ Yes
Ep No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NoNA
ElNE
Stnic ure I Structure 2 Structure 3 Structure 4
Structure
? tucture
6
Identifier:
❑ Yes
P No
Spitlway'�:
❑ NE
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 properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
[� No [I NA
El 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
1# No ❑ NA
❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cp No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[�No El NA
El NE
El Excessive Ponding El Hydraulic Overload [I Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
11
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ TotaI Phosphorus [:]Failure to Incorporate ManureJSludge into Bare Soil
[:]Outside of AcceptableCropWindow El of Wind Drift [I Application Outside of Area
EEvideence
12. Crop type(s) Cvas4r& &-crtid4 mss at.) , 5m,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ep 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
C�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tpNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name p L Phone: ff10-'L(33 `3300
Reviewer/Inspector Signature: Date: :51�9
e 1Z/28M4 Continued

J
Facility Number: 122-4l l l Date of Inspection
Re uired 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 appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑Yes
0 N
0 N
[__1 NE
❑Yes
19No
El NA
[__1 NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1§ 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?
❑ Yes 'r"n No
T❑
❑ NA
❑ NE
❑ Yes
No
[ANA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
EANo
❑ NA
❑ NE
❑ Yes
i
W No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
$ No
❑ NA
❑ NE
❑ Yes
f� No
❑ NA
❑ NE
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes
V9 No
❑ NA -
❑ NE
12128/04

Type of Visit • Compliance Inspection O operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit ® Routine Q Complaint (:) Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: �� ((� Arrival Time:31 Departure Time: (�%Gb County: �A'" Region:
Farm Name: + Owner Email:
Owner Name: S _ Phone:
Mailing Address:
Physical Address:
Facility Contact: RO-�14 Title:
LaynOnsite Representative: 6'xyue5L
Certified Operator:
Back-up Operator:
j� Phone No:
integrator ! res
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] o [=] ' ="
Longitude: =0=' = u
a Design Current'DCurrent­
❑ NE
QAp-jR_
Design Current
❑ NE
Swine ; Capacity Population
Wet PoulYy CapacityPopulation
C+attleV`'- Capacity Population
❑ Yes bNo ❑ NA
❑ Wean to Finish
❑ Yes *No ❑ NA
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
(7
Dry Poultry X�`
❑ D Cow
Farrow to Feeder
— - "`"m
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turke s
Other
❑ Turkey Pouets
❑ Other
❑ Other
NumberA of•SUM ctures:41-716
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 )% No ❑ NA ❑ NE
❑ Yes ❑ No ONA
❑ NE
❑ Yes ❑ No NA
❑ NE
J
❑ Yes ❑ No ;R NA
❑ NE
❑ Yes bNo ❑ NA
❑ NE
❑ Yes *No ❑ NA
❑ NE
Page I of 3 12/2$/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No *A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Ar a—
Spillway?:
Designed Freeboard (in):
,H
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo LlNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �%. ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 N ❑ 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 EXNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes RNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes F"No [INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% ori 0 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) c4zA he"
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
QgNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
19 No
❑ NA'
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
0No
ElNA
[:1NE
17. Does the facility lack adequate acreage for land application?
ElYes
bNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer toquestion #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better elaffi situations. (use additional pages as necessary):
ON
Reviewer/Inspector NamePhone: 3 -33CE7
Reviewer/inspector Signature: Date: 8 �4 OS
Page 2 of 3 12/28/04 Continued

Facility Number: a — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f� 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 appropirate box. ❑ yUp ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 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
EffNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1�1 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
I& 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
[ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
4] No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Division of Water Quality
Facility Number�_. Division of Soil and Water Conservation
_ 0 Other Agency
(Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -,0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3� Q Departure Time: ; op County'.
Farm Name: �— Owner Email:
Owner Name: va-( 1n S Phone:
Mailing Address:
Physical Address:
Facility Contact: 'e Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: e�
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =0 [=] ' = Longitude: =' =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I0 Layer
❑ Wean to Feeder ID Non -Ira ei
❑ Feeder to Finish
arrow to Wean o
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
'�Deslgii Current.=�:,
Capacity P4pulattorf,
❑ Dairy Cow
❑
Dairy Calf
❑ Dai Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoyA
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
[I No
NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[�No
NA
❑ NE
❑ Yes
T110
❑ NA
❑ NE
12/28/04
Continued

lhacility Number:\67—'14 l Date of Inspection
Soil type(s) cG`.6 ,
A
Waste Collection & Treatment
,gyp,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NoNA [INE
Stryctgre I St ruc 2 Structure 3 Structure 4
b �C�
Structure
5 uncture 6
Identifier:
❑ NA
❑ NE
.Spillway?:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1� No
Designed Freeboard (in):
❑ NE
IT
4A
Observed Freeboard (in); '%
❑ Yes
No
5. Are there any immediate threats to the integrity of any of the structures observed?ElNA
❑Yes
®N o [:1 NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
r
UNo
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift ❑ Application Outside
of Area
CP
12. Crop type(s) I y , �YZ & Y
13.
Soil type(s) cG`.6 ,
A
Reviewer/inspector Name Phone: 0 V33 33DO
14.
Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
5No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1� No
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
r
UNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A
Reviewer/inspector Name Phone: 0 V33 33DO
Reviewer/Inspector Signature: Date:
121281OX Continued

Y -
Facility Number:Date of Inspection 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o [:INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes l No ❑ NA ❑ NE
the appropirate box.
❑ PEI Checklists [I Design [I Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 No
❑ NA
❑ NE
❑ Yes No
�A
El NE
El Yes ,�lo
❑ NA
❑ NE
❑ Yes_,�UNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ NA NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
IPLNo
❑ NA
❑ NE
❑ Yes ff_No ❑ NA ❑ NE
❑ Yes 1�No ❑ NA ❑ NE
❑ Yes Zallo ❑ NA ❑ NE
❑ Yes E,No ❑ NA ❑ NE
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
ELI
Date of Visit: ' Arrival Time: Departure Time: % County: Region: pe 0 -
Farm Name: P _6 _ -- Owner Email:
Owner Name: _ lei-eSC Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Design Current
Wet Poetry Capacity Population
Title:
Phone No:
Onsite Representative:
❑Dai Cow
ED<
o Feeder
Integrator: Pee;`j{
❑Dai Calf
to Finish
=5 �,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o =I = 11 Longitude: ❑ ° ❑ ' E__1 "
Design Current
Swine Capacity Population
Design Current
Wet Poetry Capacity Population
Design Current
Cattle Capacity Population
o Finish
❑ La er
❑Dai Cow
ED<
o Feeder
❑Non -La er
❑Dai Calf
to Finish
=5 �,
Dai Heifer
to Wean a
D Poeilt
ry
❑ D Cow
to Feeder
'"'Y"
El Non -Dairy
EFarrow
to Finish
❑ La ers
❑Beef Stocker
Beef Feeder
❑ Pullets
❑Beef Brood CoTurke
s
❑ Turke Poults ❑ Other
Number of Structures:
MWPR.'."x'd'r.�.'iwi'r..:.,,
.4'-,"�iS�.;:.a`�'a`c
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?
Page I of 3
❑ Yes Vo ❑ NA ❑ NE
❑ Yes
❑ No2
NA
❑ NE
❑ Yes
❑ No
ED<
EINE
L94A
❑ NE
❑ Yes
0 No
❑ Yes L_fNo ❑ NA ❑ NE
❑ Yes L] No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: j3 L{ ( Date of Inspection g_2�_7
Waste Collection & Treatment VA?Ao 4
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: M 6.5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
through a waste management or closure plan?
❑ Yes 04 0 NAEl NE
ElYes ElNo OX'S A ❑ NE
Structure 5 Structure 6
1:1 Yes No E] NA ONE
❑ Yes [D/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental the eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes r��/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) WNo
4. Does any part of the waste management system other than the waste structures require ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [)9 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:1 Yes ij] 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) Gx6w Nuc" ,S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
MNo ❑ NA ❑ NE
EDNo [:1 NA 0 N
No ❑ NA ❑ NI?
[�9No El NA ONE
® No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name Phone: l to "(55-
Reviewer/Inspector Signature: Date:
Page 2 of 3 11/18104 Continued

•
Facility Number: Date of Inspection `a7
Required 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑Yes [V No El NA [:1 NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Main Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
� o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes:
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f`] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D No
❑ 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 [V No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
141 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additional -Comments and/or Drawings:;
Page 3 of 3 12/2$/04
Page 3 of 3 12/2$/04

J
Type of Visit ® Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 144J47104_1Arrival lime: 8 Departure Time: County:
Farm Name: Owner Email:
Owner Name: Prc [Ci4C _ rav Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Region: F-147-0
Onsite Representative: R.,,, dto\k A", L _ Integrator: P. c s+se t ,
Certified Operator: !I 0.,L QSQ e.k Operator Certification Number: 1'I 7 4 4 _
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: [ 0 = [� Longitude: ❑ ° ❑ ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder 10 Non -La et
❑ Feeder to Finish
® Farrow to Wean Q, 000 I J.;x3
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other T -.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .`:.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dairy—
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co k
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 [53 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
®No
El NA
❑NE
F-1 Yes
®No
❑NA
[:1 NE
12/28/04 Continued

Facility Number: 8,' —y // Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier p _
Spillway?:
Designed Freeboard (in): i 9 " cz--.q7• .6 " 3 �; /1; 7
Observed Freeboard (in):
S. 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 ® No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes JK1 No ❑ NA ❑ NE
❑ Yes 51 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 Q No ❑ NA EINE
(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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [,Z 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?
18. Is there a lack of properly operating waste application equipment'?
Can.-, -V-C- +C3 tAj or k
6CYC, sIPC �5
❑ Yes ® No ❑ NA ❑ NE
❑ Yes V] No ❑ NA ❑ NE
Reviewer/Ins ector Name
P x
"'""'"
c .,
Phone
Reviewer/Inspector Signature:
Date:
/2/28/04
Continued

Facility Number: $a —1{ 11 Date of Inspection
ReiquirA Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
.2•~" 1.Y
❑ 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
P 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
[Y-1 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
©No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
m 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
EN No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12/28/04

of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
f Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Tune:
$a �
�erational O Below Threshold
M40'e'rmitted M-�rp�ted 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
FarmName: ......_._L .................. ......._......................_._...._._._ ........_._ County: _._. !►Pr? .W .W....____. �L�6 ..
Owner Name: S9 - 92 7
-----�rt,��a��..............._..r!'::!.�..__..�......_�_..........................------�........ Phone No:............ -•---............................L �_..._._,..._.._................
Mailing Address:... P .... ----..Y
Facility Contact:Title: ___ __...----
Onsite Representative:..Rapp 94v
Certified Operator: ---%l., /l....
Location of Farm:
Phone No:
Integrator: 6'es�%�x.i__
Operator Certification Number:
EJ-9'w_ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • 4 &4
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes gigio
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes Blgo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [9 -No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes gNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D -No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [moo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _.......� ............... .................. .2_ _..__._..._._.................. ...................... _... _._.... ................................... ...............................
Freeboard (inches): � `f
12112/03 Continued

Facility Number: -- Date of Inspection 3 Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10_ Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ccla
J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately_
❑ Yes 0 -Ko
❑ Yes ❑Wo
❑ Yes EI -No
❑ Yes Eg No.
❑ Yes ©moo
❑ Yes E3 -No
❑ Yes [9 -No
❑ Yes ❑.Ido
❑ Yes ETRo
❑ Yes [t], -No
❑ Yes [g -No
❑ Yes [U] No
❑ Yes [g -No
❑ Yes ®-No
❑ Yes bio
❑ Yes 0 -No
❑ Yes EiWo
Can>aent4 (rimer to ijQeshon #} Ecplam any YES artswers and/or anyrecammeada6bns or_any othericomments.
:Use drawpagsfQf fatahty to better c�la:a srtaaaoas.(ase addltionai pages as necessary} .,.� ❑,p;eld Copy � Flnal Notes � w
w
Reviewer/Inspector Name %!? r`% %'ct t
Reviewer/Inspector Signature: Date: ' 9' G jr
12112/03 Continued

` Facility Number: - — y Date of Inspection 3 -o
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
(ie! WLiP, checklists, design, maps, etc.)
❑ Yes
B -No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[g -Nb
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
Did the facility fail to conduct an annual sludge survey?
O'Yes
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
©Vo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
&No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
EWO
(ie/ discharge, freeboard problems, over application)
❑ Yes
[9 -No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
D No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑-K
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ate
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[des
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U -No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M -mo
33.
Did the facility fail to conduct an annual sludge survey?
O'Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑'Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
EWO
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
atrd/or
dditional Camments`
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I�
33 -*ncJ 3 `Y /7/', �ur� �e+� S 7 � /Pd An I �A' e an nva
5 edge .SL rtre y an6l !"4 e Cali br,*korj o� GvasAC a�P1 Ga�,'a.�
eC/ r"e., �o�/�/ 6e �';� r's�Po/ d y /fie e^Cl 0/0 ,9pt,'/ 2004
Berm roof S 4leej
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11 / �
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9
Farm /49 a As '9004/
fleCorG'S look G) cola
12112103

Facility Number: �L -ILLL
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
Time: / yzu
Farm Name: P� . County:
Owner Name: Phone No:_-�7 %_
On Site Representative: Integrator._
Mailing Address:_ � � • _ ��,szl�Lf3 $ d-L� 4 4W .
Physical
Latitude: I 1 Lon 'tude: I I
Qperation Description: (based on design characteristics)
Type of swine No. of Animals. 7jpe of Potdtry No. of Animals Type of Cattle No. of Animals
Wsow /ySP © Layer ❑ Dairy
0 Nursery ❑ Non -Layer ❑ Beef
❑ Feeder
OtherType of Livestock Number of Animals:
Number of Lagoons: ! (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1foot + 25 year 24 hour storm storage?: x3
Is seepage observed from the, lagoon?:
Is erosion observed?:
Is any discharge observed?
Q Man-made ❑ Not Mare -made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need'mprovement)
Crop type _ „_ - _ Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application? -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste Iand applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17,1996
Yes ❑
Yes El
Yes ❑
Yes ❑
Yes ❑
Yes ❑
No IR
Not -
No 9!
No ?2F
No Q
No'Z(V
Yes ❑
Nop--.
Yes a '-iNoO
Yes ❑
No0-
Yes ❑
Nop

Maintenance
Does the facility maintenance need improvement? Yes 0 No'fb;
Is there evidence of past discharge from any part of the operation? Yes C3 No
Does record keeping need improvement? Yes ❑ No
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes a No
Explain any Yes answers:
cc. Facility Assessment Unit
]2rawings or Observations:
Date: ;—' �3
Use Attachments if Needed
--- - --
7�s=i► �_ "�' }. .: � .- -''--� - -. - •-rniY r•`tir `-r..r �sz�_. .-=`���gs�!s1t''.�m r•T!�•a. ..'tins-�e��t..-.. �r n'a4_-----"Y^_ .
AOI — January 17,1996 _