820416_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p Departure Time. ounty: 9s�-r Region:
Farm Name: ` �� Owner Em :
Owner Name: t��" _ C—,t.,v 0,5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ta. y,,l [a,U Title: Phone:
Onsite Representative: IU integrator:
Certified Operator: R)A of Certification Number-`-/q&3`6/S,_
umber: qW `6/S,_
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Design Cacrent
❑ No
egn k
Current
Design Garrent
Swine
Ca a`ct '1?0
8
Wet PoinMQ_Rsi
s aci
P
Po ':
P
Gat#!e wapaci Po
t?' P-
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
MM
2gNA
❑ NE
Wean to Finish
❑ Yes
No
La er
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Dai Cow
Wean to Feeder
❑ NE
of the State other than from a discharge?
Non -La er
Dai Calf
Feeder to Finish
1
",;
Dai Heifer
Farrow to Wean
'
Design'
Cuirrent
D Cow
Farrow to Feeder
D : ,•Ponl ..
Ca ci
i'o
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
ilts
Non -Layers
Beef Feeder
LIE]
Boars
!''`
Pullets
Beef Brood Cow
.
-
Turkeys
Other
if,
Turkey Poults
Other
,i :aArlpYHw ua JiL�i&nFRI
m'..w.inu ', '•..`1Yd iu.4 ..-i" ''.::K��`
10ther
ii.ubr;e4k ... 4s'3�.:::aaus.c:Frw'3".I'
_.Seliu..iulniafiBF'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
2gNA
❑ NE
2. Is there evidence of 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 1/412015 Continued

Facili Number: Date of Inspection:
'Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F, No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
1k
Spillway?:
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
Designed Freeboard (in):
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
Observed Freeboard (in): 36 y
❑ NE
Required
Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
No
❑ NA
❑ NE
20.
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?
the appropriate box.
T
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
1P No
❑ NA
0 NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M 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
Am 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 ❑ 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❑�rEviide�nce�o%f Wind Drift ❑Ap�pllication Outside of /Approved Area
12. Crop Type(s): Cr SS 1(Ir _)�
13. Soil Type(s): A i �% Nag
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
(,j No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes{
No
❑ NA
E] NE
acres determination?
1k
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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ [_ease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rNo
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: jDate of los ectioo:
-24, Dfd the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Va No
❑ NA ❑ NE
Otber 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?
any
to
Reviewer/Inspector Name: IV -06+ ma'&
Reviewer/ Inspector Signature:
Page 3 of 3
❑ Yes 1�No
❑Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
Phone: [phone]
Date:qlxjI
24,2015

.` "�- Division of Water Quality .
Facility Numbe#er Conservation
® O#her Agency
type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 12,lg 1 /1& 1 Arrival Time: ;O ti Departure Time: Q E1D County: 2$yLf Mj Region: 4*14c>
Farm Name: P_ J700 Owner Email:
Owner Name: P} -PS• e_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: 9wits-e
Certified Operator: ativii5 mg Lit_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
a.
051-
m e
Dme �Capaci�y P -op, Wet PoultryCapa ity Pop. Cattle Capaciiy Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
-
-Design Current _
D . Pp[il .a aci P,o P.
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
I
I
Beef Stocker
Gilts
eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othc 641 Turkey Poults
Other
Other
Discharges and Stream Imyacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [-]Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No E] NA ❑ NE
�IA a. If yes, is waste level into the structural freeboard? ❑ Ye o E]NE
Struct 1 Structure 2 Structure 3 Structure 4 5tructur Structure b
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): it�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo E3NA E]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 Ig No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesTTTI�°�No
❑ NA ❑ NE
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ 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?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
❑ NA ❑ NE
Page 2 of 3
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONO
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
2/412011 Continued

facility umber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®T No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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 R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (g 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:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes na No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[# No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No E] NA
T
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments ( q Por=any atter
ans sas
?
necessary)ndat,ons
Use drawings of facility to better ezplain: siteiat se additional page
eommeafs.
.K
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7fi1-�I3�3e�
Date: 4129/ lb
214/2011

(Type of Visit: O Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Q ' County:JXI'$ 4"" l Region:
Farm Name: V-3co
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
u
Onsite Representative:
Certified Operator: TkAw, 1,5 NAJ,
Owner Email:
Phone:
Integrator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated 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 0 No ❑ NA ❑ NE
❑ Yes
Design Current
-
Design
Current
Design Current
Swine
Capacity Pop.
W.e`t Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Mon -Layer
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
7
Design
Current
Dry Cow
Farrow to Feeder
.
.. Diy Poult ,
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
rjOthcr
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
VD NA
❑ NE
❑Yes
0 N
PNA
❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

R�
Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
Structure 3 Structure 4 Structure 5
5_ Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
TT❑'' No P NA ❑ NE
Structure 6
❑ Yes P 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? PO
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 Evidence of Wind
Drift /❑ Application Outside of Approved Area
12. Crop Type(s):GV5 AY A /011 . S 64--7) 1 � 64,.,_,1
13. Soil Type(s): _ f rk? 1 L_'5-0/4 t jVV4.,1_f;7
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
[a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[jo No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J�D 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.
r
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements E] Other.
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q] 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 r] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E. No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

s- . s
Facility Number: Date of Ins ection:
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ft_� No
PS
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�9 No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Vq No
❑ NA ❑ NE
the appropriate box(es) below.
No
❑ NA
❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
R 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
ft_� No
PS
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
T
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explarn=anyYES answers and/or any additional recommendations:araflyother comments.
Use drawings of facility to better explarnsifiations fuse additional pages as necessary):
_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ezq
Date: /,(// ��
2/4/2014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: County• Region: rP-0
Farm Name: Owner Email:
Owner Name-.7�e.—�— 1 ' —7 Phone:
Mailing Address:
Physical Address:
Facility Contact: C`c S �Y�n Title: Phone:
Onsite Representative: ts� Y�� Integrator.c--pr-e_S^L 0,L
Certified Operator: et Certification Number: / r a w
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design:Current
[—]Yes
Design
Current
Design
Gurrent
Swine_ Capacity :Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity
Pop.
Wean to FinishI
® NA
❑ NE
ILayer
❑ Yes
❑ No
Dairy Cow
❑ NE
Wean to FeederI
INon-Layer
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Dairy Calf
[] No
Feeder to Finish
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
Dairy Heifer
❑ NE
Farrow to Wean
❑ Yes
L
❑ NA
❑ NE
Dry Cow
Farrow to Feeder
D . foul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other �`*
Turkey Poults
Other
Other
Discharses and Stream Impacts
I. Is any discharge observed from any part of the operation?
[—]Yes
r5No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
®NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
® NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
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 2/4/2014 Continued

L acility Number: ]6 :;1 - {-} j (o I jDate of Inspection: Mw 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
0 No ❑ NA ❑ NE
❑ No ,® NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7(J
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 ❑p No ❑ NA ❑ NE
waste management or closure plan?
1f 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 Vg No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ig No ❑ NA ❑ NE
maintenance or improvement?
1 I. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E) 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
Cg 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:
2I . Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA F] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: T `[5;;,l -4+ 1(Q 1 jDate of Inspection: f J
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No
the appropriate box(es) below.
�] Failure to complete annual sludge survey El 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 rile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]NA EjNE
E]NA []NE
Yes
® No
[:] NA
❑ NE
Yes
MNo
E] NA
NE
0 Yes
ED No
Ej NA
[D NE
Yes �g No [3 NA [:] NE
C3 Yes ® No [3 NA E] NE
E] Yes (a No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ® No E] NA [] NE
34. Does the facility require a follow-up visit by the same agency? [:] Yes ® No E] NA C] NE
Comments (refer to question #): ExplainanyYES answers and/drany additional recommendations or any other comments
Use drawings of facility to better explain situations (use additiaoal pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Z
2/412014

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 0 Denied Access
Date of Visit: I OJ2,11'Z, I Arrival Time: p ;fit? Departure Time: County: 4"te-fw" Region: r-90
Farm Name: �� Owner Email:
Owner Name: ,0 e_ PL r,fK Phone:
UZ
Mailing Address:
Physical Address:
Facility Contact: ,(� &rif Title: Phone:
Onsite Representative:Integrator:
Certified Operator: rl i S T'T i p� i 2 Certification Number: 00 C7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
s
DesignCurrent
Design
Current
Design Curren#
Swine
CapacttyPop
Wet?Poultry
Capacity
Pop.
Gattis_ Capaeity Pop.
Wean to Finish
I JLayer
Dairy Cow
Wean to FeederNon-La
er
DairyCalf
Feeder to FinishDai
..
I
Heifer
Farrow to Wean
Design
lCa
Curr ent
D Cow
Farrow to Feeder
D , P,oul
aei
P,oINon-DaiTy
Farrow to Finish
ILayers
I
113eef Stocker
Gilts
Non -La ers
I
113eef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
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)
❑Yes GTINo❑NA C] NE
[:]Yes ❑No
[:]Yes ❑No
NA ❑ NE
NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA [ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge`?
Page I of 3 214/2011 Continued

Facility Number: - Date of Inspection: L7
Z
❑ NA
E]NE
maintenance or improvement?
Waste Collection & Treatment
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes WNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�0 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:^
13. Soil Type(s): Aim I 67 At W43
Spillway?:
❑ Yes P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in):
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes q No
Observed Freeboard (in): 35�
❑ NE
acres determination?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 5 ] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes N] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 1
9. Does any part of the waste management system other than the waste structures require ❑ YesNo [—]NA ❑ NE
maintenance or improvement?
Waste Aunlication
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
E]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes WNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): ��l a�4 ��J u{ 1 �, SMS cual�n
13. Soil Type(s): Aim I 67 At W43
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 [P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes iM No ❑ NA F] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E� No [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? [-]Yes 5] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VI No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: - Date of Inspection: 2.? i'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 No ❑ NA ❑ NE
the appropriate box(es) below.
El Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes © No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
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 the 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 R No ❑ NA ❑ NE
❑ Yes t_6] No ❑ NA ❑ NE
❑ Yes `P'j No ❑ NA F]NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
fo No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations fuse additional uaQes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: v1 3.3J4M
Date: 414,V/ Z
2/4/2011

Type of Visit: IF Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1?;VNRegion: M00
Farm Name: P 00 Owner Email:
Owner Name: "ReSigcr_'' JYLS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S lntegrator: l r S-6
I
Certified Operator: r11 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.. Design Current
Swine Capacity Pop.
Wean to Finish
-
Wet Poultry
Layer
Design
Capacity
CurrentJEW
Pop.
Design Current
Cattle 1�CapaciLPop.
Dai Cow
Wean to Feeder
Non -La er
Dai Galf �d
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current -
D Cow
Farrow to Feeder
�.1) . Poultry
Ca aci
Po P. °
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
LiOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No Q§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 E�)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 P No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a, if yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3 Structure 4 Structure 5
[P] No ❑ NA ❑ NE
E] No �NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 0 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?
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 b�) No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ma No E] NA C] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
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 [� 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 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E3
Evide/nccee of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L 6� 5� S �l ¢2.. I �. _ GVir`l ©i/ ! ;
13. Soil Type(s): AL4&
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?
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
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
Q No
TT
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[D 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
[� No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
MNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�]o No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[-]Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
W No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[P No
❑ NA
❑ NE
Y'C4' e'Wed q -m-1I ,
co"Jue'4j ?-Iqw.
Reviewer/Inspector Name:ryl
i� Phone: �Q' 3ibD
Reviewer/Inspector Signature: - Date: -yq-t t
Page 3 of 3 1/4/2011

1
Division of Water ""Quality
�Faciliiy Number Division of Soil and Water Conservation
Q Other Agency
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit is Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 10 Arrival Time: Departure Time: ounty: .SLS" Region:
IfI—
Farm Name: Owner Email:
Owner Name: ii'1 �f Phone:
Mailing Address:
Physical Address:
Facility Contact: `�4(�1 Title: Phone No:
Onsite Representative: Integrator: RG
Certified Operator: , Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of farm: Latitude: =0 = 0 « Longitude: = ° 0 ' E=]"
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder I
Design Current
Wet Poultry Capacity Papulation
❑ Layer I
JEI Non -Layer I
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
Farrow to Wean i
Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ NE
❑ Beef Stocker
10 Gilts
❑Non -La Ts
❑ Beef Feeder
❑ Boars
❑ Pullets
E]Beef Brood Cowl I
El Turkeys
Other
❑ TurkeyPoints
❑ Other
❑Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes F
No ❑ NA ❑ NE
❑ Yes
❑ No
[ONA
❑ NE
❑ Yes
❑ No
q] NA
❑ NE
�3 NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes W No ❑ NA ❑ NE
Page I of 3 12128/04 Continued

Facilit} Number: Date of Inspection
Waste Collection & Treatment
Reviewer/inspector Name ,�� lr�;Phone: !D 3
Reviewer/Inspector Signature: Date:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
TA ❑ NE
Strucre I Structure 2 Structure 3 Structure 4
Structure
5
/Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lt
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
LkNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
ElNA C1NE
(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
ONo
❑ 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 ❑l Application Outside of Area
12. Crop type(s)`�
13. Soil type(s) �►� 1 �p 011��
-
-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q?)No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA ❑ NE
Comments (refer to question #,): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name ,�� lr�;Phone: !D 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 /2/28/04 Continued

Facility Number: S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JP 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 [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 I " 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
[;BNA
❑ 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
VNNo
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �2*� M Departure Time:
Farm Name: Own
Owner Name: �s� — �' Ph
Mailing Address:
County:Region: r�
er Email:
One:
Physical Address:
Facility Contact: I ,, . r� Title: Phone No:
Onsite Representative: J-0-yMS LaI '—b _ Integrator: S
Certified Operator: S&M 1`4+ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=,
= Longitude: =0=6
°=6 =
Design C=gtl
esign Current
Design Current
Swine Capacity Population
Wet Pouitry Capacity Population
Cattle CapacityPopulation
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder
I0 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ NE
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
n -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
[?they
❑ Turkey Poults
❑ Other I
❑ Other I INumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes NLA
No [:1 NA [:1 NE
❑ Yes
❑ No
r NA
❑ NE
❑ Yes
❑ No
[PNA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes �No ❑ NA ❑ NE
❑ Yes $IiNo ❑ NA ❑ NE
12/28/04 Continued

t
J
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Stricture 2 Structure 3 Structure 4
Identifier: i
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 properly addressed and/or managed
through a waste management or closure plan?
❑ Yes�jNo El NA C3 NE
El Yes [[�] No KNA ❑ NE
Structure 5 Structure 6
❑ Yes r No
❑ Yes [)TNo
El NA [D NE
El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes +] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? ((
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes[ No El NA El NE
maintenance/improvement? r
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 ElEvidence of Wind 'ft ❑ Application Outside of Area
12. Crop ty*s) l ftwo, � S 5 /k 11 tJ"101's�
13. Soil st dY�
type(s)&i,,— �r f [dsb
Ak
1W
14. Do the receiving crops differ from those designated in the CAr?
❑ Yes
T No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FANO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1P 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):
Ak
1W
Reviewer/inspector Name Phone: r33
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W)No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
6 NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesNo
tNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Imo! No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
bONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than non -nal?
ru
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IoNo
❑ 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
nNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
9jNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FjNo
❑ NA
❑ NE
Page 3 of 3 12128/04

J
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4D Routine O Complaint O Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 1*[� Departure Time: County: =4�ftf!;aA/ Region:O
Farm Name: P 3°� Owner Email:
Owner Name:
Mailing Address:
wpc-r Phone:
Physical Address: /�
Facility Contact: R_W�LTitle:
Onsite Representative: c
Certified Operator:
Back-up Operator:
Phone No
Integrator: -
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: EJo �ON Longitude: =o =1' E__1 u
Design Current
Swine. ^" jr Capacity Population
r„urexew !. e r . n_ .
❑ Wean to Finish
❑ Wean to Feeder
Wet Poultry
❑ La er
❑Non -La er
Design Curren#
Capacity Population
Design Eurrent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
-_ -_
❑ Dairy Heifer
Farrow to Wean
Dty Poultry
a. Was the conveyance man-made?
El D Cow
❑ Farrow to Feeder
ONA
❑ NE
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
/M NA
❑ Beef Stocker
Gilts 3'1.CD arl
❑ Non-Laye
❑ Beef Feeder
Boars
❑ Pullets
❑ Yes
❑ Beef Brood Co
Otherw
❑ Turkeys
2. is there evidence of a past discharge from any part of the operation?
h
s $
s �:'A":_,
❑ TurkeyPoults
❑
❑ NE
Number Struetuis:
[] Other
Other
❑ NA
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ONA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
/M 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
bbNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
/❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/2$/04
Continued

Facility Number: Date of Inspection
❑ Yes
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No
❑ NA ❑ NE
a. If yes, is waste leve I into the structural freeboard? ❑ Yes ❑ No
P NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
❑ NE
Spillway?:
F3 No
Designed Freeboard (in):
❑ NE
14
Observed Freeboard (in): __43
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
18. is there a lack of properly operating waste application equipment?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes "No
[INA ❑ NE
through a waste management or closure plan?
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate pubUc health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C& No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes roNo
❑ NA ❑ NE
mai ntenance/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 f Wind Drift ❑Application Outside of Area
12. Crop type(s) s GnL11
13. Soil type(s) 6;IA � "VSA t 049 nam r ��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ 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
F3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
1PNo
❑ NA
❑ NE
•,� .� is-� �� ��Lx��� ���.3'�
Cnm is (refer to"'questioq#): Explain any YES answers an�/o��any rk Ofiendahons or an other c
omments.
011
1Use dra�f`faceErty�ste_tter eapla�n situatson� V g
m X s, {�dditroitalaa es asiiec' e s
Reviewer/Inspector Name -, Phon
ReviewerlInspector Signature: Date: 8 OS
Page 2 of 3 12/28/04 Continued

Facility Number: 2qZA i Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
i5No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VINo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6No
❑ 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
n 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
V 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
(P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[j No
❑ NA
❑ NE
Additional;:Comnaeats and/or Drawtn s5 - :` '" - .?LYZ
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

AD Division of Water Quality �I
=Facilityumber . 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I It
Date of Visit:�/�/p7 Arrival Time: Departure Time: ©County: S>�5 Region: PeO
Farm Name: Owner Email:
Owner Name: el Phone:
Mailing Address:
Phvsical Address: m- _
Facility Contact: 9 Title: Phone No:
Onsite Representative: I t Integrator: 7 acs
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=1
Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish j 10 Layer
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish
Farrow to Wean 1
Farrow to Feeder
❑ Farrow to Finish
Gilts O�
El Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
EIDTy Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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 IM No ❑ NA ❑ NE
❑ Ycs
❑ No aNA
❑ NE
❑ Yes
❑ No ,15 NA
EINE
❑ Yes
❑ No ANA
❑ NE
❑ Yes
�W No ❑ NA
❑ NE
❑ Yes
A No ❑ NA
❑ NE
12/28/04 Continued

acility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ja No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LN
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 P] 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 ❑i No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/improvement? /
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tj 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) 0
a..r'ec's Y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[71Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a..r'ec's Y
Reviewer/Inspector Name llv` vt Phone
Reviewer/Inspector Signature: Date:
12/28/04 Confinued

• Facility Number; 19A Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesNo ElNA E]NE
the appropirate box. ElWUp ❑ Checklists ElDesign E]Maps E]Other
21. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
❑ 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
I)_.d)No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes UNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
4 N
❑ 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?
ElYes
LNo
❑ 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
k No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
N
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[:�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Date of Visit:J [/ d`j� Arrival Time: r� Departure Time:
Farm Name: P(' ' 3co
Owner Name
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l
Certified Operator:
Access
County: �b "` Region: 10'{
Owner Email:
Phone:
Phone No:
Integrator: Pres' 4
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ I ❑ 11
Longitude: ❑ ° ❑ ' ❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
El D Cow
El Non -Dai
El Beef Stocker
El Beef Brood Co
❑ Yes �No
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 1 of 3
❑ NA ❑ NE
❑ Yes ❑ No ��,,�NrA El NE
El Yes El No C] �A EINE
❑ Yes �❑�No UNA ❑ NE
E]Yes WNo
o [:INA
12/28/04 Continued
Design C►urrent
Design WC.urrentDe=11.urrent
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ NE
❑ Yes
El Dairy Heifer
Farrow to Wean
6D't
Dry Poultry
El Farrow to Feeder
❑ Farrow to Finish
❑ Layers
[ Gilts
3 X60 318 0
❑ Non -Layers
El Beef Feeder
❑ Boars
Pullets.
❑TIl
urke s
Other
❑ Other
El Turkey Poults
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
El D Cow
El Non -Dai
El Beef Stocker
El Beef Brood Co
❑ Yes �No
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 1 of 3
❑ NA ❑ NE
❑ Yes ❑ No ��,,�NrA El NE
El Yes El No C] �A EINE
❑ Yes �❑�No UNA ❑ NE
E]Yes WNo
o [:INA
12/28/04 Continued
❑ NE
❑ Yes
❑ NA
❑ NE
(Type of Visit A Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit G Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other E] Denied

Facility Number: g — 6 Date of Inspection
Waste Collection'& Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E iVo ❑—NA ElNE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No &<A' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ki
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L✓J 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 [ /. ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes g No ❑ NA ❑ NE
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 [--IPAN > 10% or ] 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)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No El NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [--]Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E5 No
❑ Yes ® No
: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):
[__1 NA El NE
[I NA [I NE
Reviewer/inspector Name Phone: 4/0 Y33-3-
Reviewer/Inspector
— Reviewer/Inspector Signature: Date: jJ
Page 2 of 3 12/28/04 Continued

Facility Number: —b Date of InspectionIOU
Reauired 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 [I Other
❑ Yes
No
❑ NA
❑ NE
El Yes
V@ No
El NA
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4. No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
LWNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
99 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R 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
53 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J9 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
0 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
[a No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `i /-7740.0-1Arrival Time: Departure Time: County: Region: F'no
Farm Name: �� - 3 O O Owner Email:
Owner Name: _ Pr Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:
_ \\
i3 r� d� � _
Integrator. Pr c s k Q- 5
❑ Yes
❑ No
Certified Operator:
S
(�`. c..��+
Operator Certification Number: a�a U St
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =4
Longitude: E__1 O =' = u
Design Current Design Current
Swine Capacity .Population' Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
® Feeder to Finish
® Farrow to Wean poi
® Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Ci
Cattle Capacity Pop
alatton . I
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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 00 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JZ] No
❑ NA
❑ NE
❑ Yes
&21 No
❑ NA
❑ NE
12/28/04 Continued

rFacilitZi Number:
Date of Inspection I X1 /-%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard'?
Structure I Structure 2 Structure 3 Structure 4
Identifier: -_
Spillway?:
Designed Freeboard (in): _ ori o� . 6 '� /d S/ 93
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 properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [9 No ❑ NA ❑ NE
El Yes El No El NA ❑NE
Structure 5 Structure 6
❑ Yes [� No ❑ NA ❑ NE
❑Yes R1No El NA [I 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 [P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [P 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 CO No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes 0 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) _W -La ,Q_ /9L 0 /9'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination': ❑ Yes [ANo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes `P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question # : Explain any YES answers and/or any recommendations or any other comments,
lyse drawings of facility to better explain sitUationS. (nse additional pages as ReCes58ry):
Reviewer/Inspector Name W/—m Phone: l
Reviewer/inspector Signature: Date: -1 �'/ !1T
/1/18/04 Continued

Facility Number: — Date of inspection MW G�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [1 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 El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
/, G
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ja No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
m No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
It 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
[XI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
� No
❑ NA
❑ NE
AddltiOQal COminentS AAdIOr �Fawln�5_:
1+� {' Y O V C..r O w C. +.+.J C r w- 1/ `X
YM. J � S � �. h a� C O� u �� "�' t � h 4Y p F. ' s i �r C. �/ C f . 7[
%lc.� ���., SL.au.McR 1-•�vc.. 3�oc�3 �..� COC
12/28/04

0
Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation
I Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number y Date of Visit: 3 - % o y Tame:
O Not Operational O Below Threshold
EFK�mitted �rtified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: p Z.300 County ......
'7�i?rr
Owner Name: ..... Phone No: -
Mailing Address:
Facility Contact: —•------------ — - — Phone No: ..............
Onsite Representative: „4 nil �u�e--------� �_----- Integrator:
Certified O erator.............. ,.. .. !1,.��.... .............................. ..... Operator Certification Number:.....2.2.�?O.... ..
Location of Farm:
GIZ'w-ine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �� ��
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes U -No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [g -No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)❑yes [�_K
c. If discharge is observed, what is the estimated flow ingallmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes &to
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [moo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes LINO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Elxb
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i ... . .... ........ I .......... ......... ...._...—... ......... ._..................... ...................................
Freeboard (inches): 3 r
12112103 Continued

v IFadlity Number- —t
Date of Inspection 3 p
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 Apolication
10. Are there any buffers that need maintenance/improvement?
❑ Yes ❑Wo
❑ Yes El o
❑ Yes ❑"o
❑ Yes Q -Ko
❑ Yes CWo
❑ Yes ❑-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [moo
❑ Excessive Ponding j ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [I Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9 -Mb
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 Imues
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 Bllo
❑ Yes B No
❑ Yes [9 -No
❑ Yes GIM
❑ Yes [Wo
❑ Yes [tea
❑ Yes 9 -No
❑ Yes t[. hlo
❑ Yes ❑ ble
Reviewer/Inspector Name4Y`�i " /err,
x
Reviewer/inspector Signature: h?v/_%'Lll� Date 3 2`0 Lt
12112103 Conditued

+ Facility Nwmber: ffa Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ©fi O
❑ Yes B'Ro
❑ Yes Q- 90
❑ Yes B -No
❑ Yes B -No
❑ Yes [--jd�o
❑ Yes [No
❑ Yes [}-leo
❑ Yes RNo
19 -Yes ❑ No
❑ Yes Q -No
❑ Yes ONO
O -Yes ❑ No
[g -Yes ❑ No
❑ Yes U-116
IMO'No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditi&;U Commenta
snd/or rDawsngs
77 ,Ce/ 1
3 ? aoI 3 y �i, e4.re 40 SIce cl
�
and !-ate Ca'.Gro'/10rl OF WGSrt cr�v1.Cu1�,'p� egvf�J.nera
t,vdvlcr f rr"`/ir`SJew Y > e/7d dT
mrf garP p&/ 67/50 5 labed k" 471 1ALea�P�aC1(
`
tn�
o rl es 104
y
9 q�'ass C.over- Ori te 4OT&_ are
Seo 5 on >C�e 0vh#'cle5 p-/' �!
rar n /00 k S 9004/
R ec etc/ S le, 0ll C, odd IVi
12/12/03