310238_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
2 V
d

-1 a-i7 �1
for Visit: ID Routine
Other O Denied Access
Date of Visit: /Z-//-( Arrival gT�ime: 3 t � Departure Time: ! j County:
Farm Name: �G� a� Y rT'� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: /4d/) IWe
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region:
Integrator: AP .YA 5 e-
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
CapaciTy
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eeder [o Finish
O o
DairyHeifer
Farrow to Wean
Farrow [o Feeder
Farrow to Finish
Dr. Y Routt ,
Layers
Design
C•a aci
C•urcent
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) ❑ 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 Cd NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ o ❑ 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 21412015 Continued

Facility Number: - ,2_ Date of Inspection: (2 -Y/
')
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
5i"F_
❑ NE
a If yes, is waste level into the structural freeboard?
❑Yes
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 12
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 reat, notify DWR
❑ 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): i kr e-rl c�n J�»� M r 4 1-, i c-t11"rl , 1?J �rQ-n—f
7. Do any of the structures need maintenance or improvement? ❑Yes VNpo"'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
l
9. Does any part of the waste management system other than the waste structures require
❑Yes
Zj No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
No ❑ NA
❑ NE
13. Soil Type(s): / /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
��Q0 ❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
No
❑ 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? 13, es 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 21412015 Continued

Facili Number: - ,j
Date of Inspection/ 2 —//
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
VI N ❑ NA ❑ NE
111��� No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: PO
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ YesNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes❑ NA [3NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [—]No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately. '
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?�
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional -recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Sct r✓4z
pp
Reviewer/Inspector Name: (3 (.t S vX—' �6 L_ Q-
Phone: l 1 /-79/--`/'L00
Reviewer/Inspector Signature:
Date: 12 //—/
Page 3 of 3 21412015

Type of Visit: ("Com ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit:
/b
Arrival Time:
Departure Time:. lJ County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: II Title:
Onsite Representative: _ / v t Ct r'` �� �F Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
Certification Number: 216-,3 71V
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Curren[
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
2 �
'LW'50
Dr. P,oultr
Layers
Design
Ga aci
Current
P,o ,
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ❑D❑,NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: 2 Date of inspection Z
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
25'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 peat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yesg�N_
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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
❑ NE
❑ NE
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 �0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes N No
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNoNo
❑ 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 JWNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections `0
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 0Noo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �a
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

1
Facili' Number: 3 Date of Inspection: 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.
❑ 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 I XNO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes "Y❑`YY' No CIA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes [;(No
[—]Yes ][ No
❑ Yes 0
❑ Yes ] No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
IComments,(refer to question #): Explain any YES answers -and/or any. additional recommendations,or, any other comments. I
Use drawings of facility to better explain situations (use additional'pakes as necessary).
e� E S(,/"
C' �� � n � t 7(• rl �'ecoic�s_
�fCai�now. lyC7 e-
/N5 Gc to a5�9�rCCo�fy-
-e/< le, 5•0,5 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
II o 3�z 010`1 ry_jcAr.)0✓
jo- L ' P° L-e 11.4.
H,t
Phone: II� ( I��19 739 q
Date: C a l b
2/4/2014

(Type of Visit: (yCiance Inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for VisitRoutiinne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f 2J `�/�}7 Arrival Time: � Departure Time: 1('L/� County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
e. Ttl l/a 7 i
Latitude:
Phone:
Phone:
Integrator: /�
Certification Number: / q / PF 2V
Certification Number:
Longitude:
Swine
Wean to Finish
Desigo Current
Capacity Pop.
I
Wet Poultry
11-ayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
INon-Layer
IDai
Calf
f.
er to Finish
<o n
r
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P:Dolt .
La ers
Design
Ca scih
I
Current
P,o ,
D Cow
Non-Dai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [!No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑1No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Fa ili N mber: jDate of Inspection: I z'
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
t'
rZ c
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 3 Structure 4 Structure 5 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Ef7No ❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Z< ❑ 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 [TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
�N"oo
dpro
❑ 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
❑ 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
❑ 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-
2 1. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes EXNo ❑ 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 o ❑ 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 21412015 Continued

Faeili Namber: -
Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
eN�❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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 Ea -NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[�N - ❑NA ❑NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: "`-✓ Date:
Page 3 of 3 21412015

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 9 Arrival Time: q S Departure Time: ® County:�� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: yelm ?PmE Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 9 C W3_7
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Desigtt
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
D Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr P,oult .
Layers
Design
Ca aci_
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
lather —TurkeyPouets
El Other I I
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ZNo ❑ NA ❑ NE
[-]Yes []No
[:]Yes [-]No
❑ Yes
❑ Yes
❑ Yes 2No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of Ins ection: ( t
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V 0
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No
Structure 1 Structure 2
Identifier: LA G_V�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 195
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[—]Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [1 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M�M ❑ 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 7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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?
El
O 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
E No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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. dyes ❑ 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 u N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes VNoNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FAcility Number: jDate of Inspection; 11 G I1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
AIs the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes La No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EfNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the pemtit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes E!rNo ❑ NA ❑ NE
❑ Yes DKO ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes WO
❑ NA ❑ NE
❑Yes❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any'other comments. r
Use drawings of facility to betterexplain situations (use additional pages as necessary). '
l5,) 1J6W LJW PAS (25UMV0A/SCO, ► bC-P 1a FSTiq�z�s� QFITEIL
clzivEO_A(r. , f C-SGt)C njC-e 05 to (&E ReM.OIF-0,
a,)) lqo y,^.ZN.sec-cr*.(r%s NC-(-o ro gQ 12C-.C60-DED
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C9 1b C — / 3 6 (1
Date: 1 9
2141264

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QJRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jj':Arrival Time: Departure Time: County:
Farm Name: �/1t T n PlAk Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: AAafAg l
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Region: W l R D
Integrator: [[��
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 11
Wet Poultry
[Layer
INon-Layer
Design
Capacity
I
C•ucrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, j P,oult .
Layers
Ca aci +
P,o ,
'
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Cher
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes RjNo ❑ NA ❑ NE
❑ Yes
LZ�No
❑ NA
❑ NE
❑ Yes
(TNo
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
[:]Yes ZfNo ❑ NA ❑ NE
[—]Yes 2No ❑ NA ❑ NE
Pagel of 21412011 Continued

r acility umber: - 2 LB jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;a 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
21 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
Z] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E�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
&o
❑ 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 V1 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ;n No
❑ Yes ff No
❑ Yes 2TNo
❑ Yes No
❑ Yes / No
❑ Yes 71No
[:]Yes VNo
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;?fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 21412011 Continued

IPacility Number: 2
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [6 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No
❑ Yes No
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes 171 No ❑ NA ❑ NE
❑ Yes 0/ No ❑ NA ❑ NE
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F ] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
PI No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspectm Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:ha-31��-aa�D
Date:
21412011

Date of Visit: fS Arrival Time: 1 � Departure Time: County: �W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: 'Ic-EI'TA P(-1F_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity P.
Wean to Finish
Wet Pltry
La er
Design
Capacity
Currentou
Pop.
Design Current
Cattle Cpa acity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
D . P,ouI
Layers
Design
-a aci
Current
Pao .
Da Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
lBeefBroodCow
Boars
Pullets
I
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
[-]Yes ❑ No
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes � No
❑ Yes 1Po
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
�[
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IIXI No
7❑`�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: [A603 N
Spillway?:
Designed Freeboard (in): q,
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
n�
I /t No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
i�
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
14
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 0{,
9. Does any part of the waste management system other than the waste structures require ❑ Yes '7� No ❑ NA ❑ NE
maintenance or improvement? 7�
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 D(I 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): Cesc_-,& _ �w cf-Gin
13. Soil Type(s): 0(6� I r c-C
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
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
Reunited 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.
❑i WUP ❑Checklists [a Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑�Aiste Transfers '❑ Weather Code
o 1 Rainfall 0 Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections 0 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 21412011 Continued

Facility Number: jDate of inspection: I 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
r,
17� Yes
[:]No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
7❑Yes
❑ No
N NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
�t
❑ Yes IY 1 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
7�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Rj 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 IXI No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
i
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes WNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
jNo
ElYesNA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question tl): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CaupVE. 2Gl 9
- So l C ax�x�S Fb f 4 D' tf I G t } rroGZ Cam• -1 �.� Ou 7 L,45 E A (Z LAO-S
(,�[— SpML CCDV 7_1 A11VA i t�N r�t+&N S AM pQAWn
rlNG—So ft�A (AN6's j-(L6WI LF4Goav
sRf��o�ve�t-I,t�r� Mee
/ p1�C- - AAUl--U1-1
to)P) /I () 1 • 5(o r p Vl0(-Ai10"'
oX Fes-
-1 EED 1 C> �c A--T C s i 3 yY5
o,\6fF_c ,cv 7 �Aq
cpnj 61%'rH6" g�vlC-
N6E� ,o FIAD C
' -kT
I�/yo7 _ NC-G- iC> PING c>NG ArnV = AmauoA �alw•�s
mEEp Tc7 SfcAID JE6t-I e1LAT1arlC3�01G c>
C '""fTnfC_"Rb4 S16NATtn4C
CG�c�oF
aF GlL 10'3 �%
CU13CuAiC. FCSCIAE_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S
Phone: 910-7 � I1 —I �.4 0_13
Date: /lO
21412011

Date of Visit: Q { Arrival Time:® Departure Time: County:
Farm Name-. e— ITN' P141 E FI Z AA, Owner Email:
Owner Name: j'F(TN `'AIL`- Phone:
Mailing Address:
Physical Address:
Facility Contact:
JUG E Awe 463
Title:
OnsiteRepresentative: —FO TH ?.476 Certified Operator: OI CNA6L- C/�. 171 Lge ZT
Back-up Operator:
Location of Farm:
Region:
3u,N l U L 1 UE 1Vr r05�- 3 (DS
Phone:
I1g r�ator.
'OLO I I
Certification Number:
Certification Number:
Latitude: Longitude:
9I>9
Swine -
Wean to Finish
Design Current
Capacity _ Pop.
WetYoultry
I ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I. jNon-Layer
I
Dairy Calf
Feeder to Finish
LR140
/
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oult , Ca aci $o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yesto
❑ NA
❑ NE
Page I of 21412011 Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
9No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �.1g6p6�
Spillway?:
q
Designed Freeboard (in): ! -S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? �q Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VkNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 77TTTT_[������
9. Does any part of the waste management system other than the waste structures require ❑ Yes T 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 01,
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):
- Aal OWN
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Q WUP El Checklists Q Design 0 Maps ❑ Lease Agreements
Yes
NNo
Yes
❑ No
❑ Yes
No
❑ Yes
,,�((j
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �aste Transfers
Q Rainfall ❑ Stocking,0 Crop Yield 0120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectioon..{{s,,
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 IiT]�lI`No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection: 10111711
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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
77777T"❑No
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
X NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
I XI No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
�TTTTT""�XX��ll
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
4No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
��1
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations
(use additional pages as necessary).
CAW_l(@Q_fT/ 0/V 620 o�
cEn SEMI Olc ��516 /aT�O�/ ratLk io coAA16E FV-0AA
wl CAL CG--rt-C TO �IGH�I$L 11ILg�CR-I
LOFT 0=W(M'3 FaVL
FctE,Eg�r+'z� _ NEE 1 o c ts� 7ti�f
Fof�dTol�tlrT1AL Ilro�fnEA;E(,ZQA��GA�L
JL
�b�µ t_NAt-L7NE
v w�6D-w►�C Ei
5 F6'Scc.E fIGLDS
�iELQS
�. nIL0D I v /►1QW EN�Ia-E �-��oN — f1..FLnnovE SA�GIN�i S 7� i UC orrDlK�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q16 - ` (N�
Date: 6 l
of]

(Type of Visit: JD Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 16 Routine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: I y/o7g/// I Arrival Time: Departure Time: County: UIV Region:
Farm Name: ',L`C 1-1PP C FAy N't Owner \� A 1 C Pona Email:
rk Owner Name: �E 1714 i�i 7 C (� Phone: t ai/� - 3 g 5- S ) Q� /� p
Mailing Address: ���
OW n� 1/ /t N j U U C 0 AU O 3(0 S
Physical Address:
Facility Contact:
Title:
Onsite Representative: �)Q (j yw tin sib Integrator:
r
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: /
Q�s,a ti
Certification Number:
Certification Number:
Latitude: Longitude:
Swine -
Wean to Finish
Design Current
Capacity Pop. -
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
en
Dr, Poultry Ca act_ P,o
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef. Feeder
Boars
Turke s
Turke Points
Other
I lBeefBroodCow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No NA ONE
Yes No DNA NE
Yes No DNA ONE
1
Yes I/I No NA D NE
Page 1 of 21412011 Continued

Facili Number: - Date of Inspection:qlj 0
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[2 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Z
Structure 5
Structure
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): <
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ 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
;Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ffNo
❑ 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
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
,ffNo
[DNA
❑ 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
[X No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
1' 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
FME
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
�1 E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
Q 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 ,fNE
❑ 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 'E N
Page 2 of 3 21412011 Continued

Facility Number: 1 - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA JDINE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ETNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA � NE
[:]Yes [:]No ❑ NA [ENE
❑ Yes ❑ No ❑ NA ,❑ NE
❑ Yes ❑ No ❑ NA J2 NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA M NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA J�j NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [:]No <A ❑ NE
34. Does the facility require a follow-up visit by the same agency? YI es ❑ No ❑ NA
C(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments: _
Use omments drawings of facility to better explain situations (use additional oases as necessarv). '' ` w
S� /gees o4 X?506rr7 6vRYl %Wnl7o he Cal Ql JOL
Sf--al AleI66 /feel Cokzl,,ol `%flay 1tfWle ou evQ�r,�lovt
ZY an
AdYICCml(q� (nos w(( (PSJV
Reviewer/Inspector Name:
Phone: 7//f 117.-,—
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 214YI011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Timer: ' /o Departure Time: County: L1!✓ Region:
Farm Name: Y C-I TH ?Q T G 1-AQM Owner Email: /�/�
Owner Name: hrtT� 1-ATQ_ Phone: q)0-2p :5-5//40101)
Mailing Address: �S J� L� ` A �ON \t 8 mO_LN J 0 t-I U C 1/ v C d O &_Q S
Physical Address:
Facility Contact: Title:
Onsite Representative: �Gl7�f PA j C
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , °° Longitude: = o = ,
.. #tM'3
` Desrgn .: Current .w ,," Designnw, Current ,{ I)estgn Cur en
S«rne Capacity Population Wet Poultry Capacity Population Cattle Capacity' °gPop�ulatibn `
❑ Wean to Finish
❑ Layer
- ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
L�
.„b-° ' "`�'3-, *::"r
D Ptitilt''''"'^"'"��'T
ry L"sktiY.c>
❑
LaersFarrow
❑ Non -Layers
❑Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
- El Dry Cow
: ❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures•.
Farrow to Wean
El Farrow to Feeder
❑to Finish
❑ Gilts
El Boars
Other - ." "
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 6AQ0 Rl
Spillway?:
Designed Freeboard (in): 1 9 -•S
Observed Freeboard (in): 19's
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 1_No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1XNo ❑ NA ❑ NE
❑ Yes WSJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ 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 oNo ❑ 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 li" C No
❑ NA ❑ NE
0 Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of
Area
12.
/
Crop type(s) �Gt V Sto G !s 56 cG N " +(A j
13.
Soiltype(s) nk&
M c C
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,o No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes �No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes gNo
❑ 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 I pPhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 - 12128104 Continued

Cr
Facility Number: —a3 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 appropriate box. 0 WUP ❑ Checklists El Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ V/aste ✓✓✓✓✓✓Tra"````nsfers ❑ ttual Certification
❑ Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
bd No
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
No
P
❑ NA
❑ NE
❑ Yes
No
El NA
❑ NE
ElYes
No
❑ NA
❑ NE
❑ Yes ❑ No )kNA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes to
Y°'t No
❑ Yes o
ElYes
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 3 of 3 12128104

IType of visit _,&Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit 5LRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I I S 09 ]Arrival Time: /0 s Departure Time: County: Region:
Farm Name: YCS 1 4 \( P-rC-- VASZ/� Owner Email: Q
Owner Name: � `E 1 TN 1—A T Phone: I IO-3o S—SI pt 3
- —
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: \l`EITH ?A —le Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: [� o
'-Destgn Current Destgu'Cu`rrent'y,__b" -
Swme Capacity Population . Wet Poultry Capacity Popullationt Ca[tale .«5.
De, ss�gnC+uCrent
Capacity Population'
�:-
❑ Wean to Finish
❑ Layer
❑
Dairy Cow
❑ Wean to Feeder
h ❑ Non -Layer I
❑
Dairy Calf
Feeder to Finish
y
❑Dai
"y n
Poolt ;r �- ❑
ry El
ers
❑
rE]Non-L
�Ia ers ❑
llets
srke
Heifer
(.
❑ Farrow to Wean
❑Farrow to Feeder
El Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
=.
❑ Gilts
Boars
Beef Feeder
Beef Brood Corke
z
-
Number of Structures:
Pouets
ElOther
❑ Othe
i
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
12128104 Continued

Facility Number: ) — Date of Inspection aU3 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: `/):a'001V
Spillway?:
Designed Freeboard (in): 9 S
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes g No ❑ NA ❑ NE
❑ Yes I,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No [I NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) s,s,,,,,,
9. Does any part of the waste management system other than the waste structures require El Yes 0,No [INA ❑ NE
maintenance or improvement? \\
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PqNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A 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) FE3euGi/4) CAWV SouoaANS
13. Soil type(s)
C- ,
14.
Do the receiving crops differ from those designated in the CA WMP?
❑ Yes 'P�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes � No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes JN No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes ANo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ANo
❑ NA
❑ NE
;rkco .
Comments (refer to question #): Explain any YES answers and/or auy recommendations or any other comments
Use facie of drawings to better explain (use,additional es as n
pages a necessary)-
facility Rn situations. (....R :
U)' A� a, C>
WI 110
Reviewer/InspectorName I 1NE s: I Phone: `00-711 f3a1'�
Reviewer/Inspector Signature: _ Date: %( 5`09

Facility Number: 3 — Date of Inspection 11
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. Q WUP ❑ Checklists El Design ❑ Maps ❑ Other
❑ Yes
gJ No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Y(aste Transfers ❑.Adutual Certification
El Rainfall ElStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ❑ No
❑ NA
�q NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
�qNA
❑ 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 [I 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 A 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 �I 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 4 No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes W�No ❑ NA ❑ NE
Additional Commentsjaud/orrDraw�ugs
n1e�D Con�oF &0009 oiC- C00., - p��Asc sin id a�a
-_A,X TO
A DQ GA1N��
►�- 35�
(,1PDRir wUC' 704ZEmoue Vr:GE1AgCFg-IAc� tat7if
FtLG$
CyGK o/v
E
,,,PotTr C&(7C6IEL�> ?C-) 1N«9c coq/V-r$3�5ga//V5
12128104

0 Division of Water Quality
Facility Number 1 � 1 11 a.YS � 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: LI Al Region:
Farm Name:
Owner Name: `KITH NWTE
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
OnsiteRepresentative: e,177-H �aTE Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: = o =' = "
r
Design 'Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish J,❑ La er
❑ Wean to Feeder ❑ Non -La er
® Feeder to Finish on
❑ Farrow to Wean Dry Poultry
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
E]Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design.
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: :FJ
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
❑ Yes jxNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'N No
❑ NA
❑ NE
❑ Yes
�Io
❑ NA
❑ NE
12128104 Continued

Facility Number: 3) —a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure,, // ��, 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGGOA/
Spillway?:
Designed Freeboard (in): % • S
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
Z 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
W No
❑ NA
❑ NE
8. Do any of the smctures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ 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 A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fitNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
kNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
Vf
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
coq( Op 01c, cARR b t sGNT�' TO
(AMA&fj)A GRlIVES
19-4 c_ A011VfFC-"b�L C)1 GQ FPrX q�4 - 350-d6oy
. W t t_ to t Nf Tom, AIn„ _ •
Reviewer/Inspector, Name I Phone: 110-1
Reviewer/Inspector Signature:Act;" Date: 9� 01�rl
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D4No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
and report the mortality rates that were higher than normal?
19
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ 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
kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JffNo
❑ NA
❑ NE
Additional Comments and/or Drawings:.
Page 3 of 3 12128104

•.� Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
11 0 Other Agency
(Type of Visit i?f cci pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t0 Routine o Complaint 0 Follow up o Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: O 07 Arrival Time: 4d0 Departure Time: County: 1 Upyrx) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: k t, 11+1 ?AIC
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Title:
Integrator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: =o =, ="
Design Current'
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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 En No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes El NIA
❑ Yes IJNIA❑
NA
❑ NE
❑ Yes U! No
❑ NA
❑ NE
12128104 Continued

Facility Number: '{ — 238 Date of Inspection / a
Waste Collection & Treatment
4. Ie storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structur 1
Identifier: LA Cr�o
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
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 YJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [A/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Gi�Yes ❑ N [I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/No ❑ NA ❑ NE
maintenance/improvement? ,�,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V(No ❑ NA
❑ NE
rm
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]�
Yes
❑ NA
[I NE
Does the facility lack adequate acreage for land application?
El17. Yes
la ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
?,) 3PLK.S.Cf)E 0ACk PALL- PPk0 S Ct fA� t CT
Iq,) NE6o L40T& NrEW C,C �ERanZT Arta PLACE u%
tZkcntt.OS.
UPAAtE wue Ada_ W( 3 opue F1 oTM:E6" ✓ 0FkTC
Pv v Per W�rlbom 1 or!
5eSW E ,
Reviewer/InspectorName pa (ct1
Phone: 79(. %3 X
Reviewer/Inspector Signature:
Date: tp S o
12126104 Continued

Facility.Number 3 t —a3 Date of Inspection F
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage &Permit readily available? dyes ❑ No [I NA [I NE
20. Does the facility fail to have a components of the CAAW readily available? If yes, check � Yes ❑ No ❑ NA [I NE
the appropriate box. WUP ❑ Checklists El Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections/
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
1 o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,
LJf1�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[IYes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
u1
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
V
❑ 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
ElE 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?
❑ Y7No
❑ 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
ElYeses
❑ 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
/Nq
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
. o
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I
I -- _ -- _ Division of Water Quality ,
Facility Number i 0 Division of Soil and Water Conservation v/
Other Agency
(Type of Visit Q _C�o[mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 04outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Y Z >G Arrival Time: F Departure Time: County: 0U LT Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A(1 rg ✓ ne,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
=�
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0ll Longitude: 0 o 0' 0
11
.Design Current- - .Design -Current Design
...Capacity Population Wet Poultry Capacity Population Cattle -Capacity, Pt
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
U Farrowrrto Feeder
n Faow [o Finish
Boars
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ 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?
Page I of 3
❑ Yes E' No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[*
❑ NA
El NE
El Yes
[�'/No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I/ Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2'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
eNo ❑ 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 environme al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ /No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I�I 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 LJ 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 l(J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) h 6,q) Ct,>f VE6 t; %I ) L<-
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
LJ No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[ZlYYes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑Yes
Zo
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #)i 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):
7) •LJ Ua 0b D.I.k6 G✓ALLS N &&D CL649.7N G• at— ,eLlWiU4 -
►S) 15AC-jk- F&S' uE rT61D 3•i✓ ad 0 fh"6 avEOLGfl-0wxl t`J'VV w�601,
9.0.) N E S A� p�J 0 t r.T611 CD �B
Z.l A#AjvA L CET W=> Q IZECoW S
tie0Q. 3emb VWQ
Reviewer/InspectorName 69AILLV Phone: % 3S0
Reviewer/Inspector Signature: Date: a 3 vL

Facility Number: ?� — Date of Inspection I bt.�3[�frJ
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Ye
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAP readily available? If yes, check
Yes
El No
[I NA
❑ NE
the appropriate box. ElWUp El 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
Wnnual
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
Oo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
NNoo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,
N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
7No
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L7 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej'NN9
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
rJ 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
ETNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
CI
❑ 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
J,2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit qfRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Q Departure Time: " County:
Farm Name: ��!21� 15 / Owner Email:
Owner Name: �i�G7i`% Pw Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: /i7s
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
o F- [7 Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
JB Feeder to Finish
1Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
ru�u�m
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
—J
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes XNo ❑ NA ❑ NE
❑ Yes/No ❑ NA ❑ NE
12128104 Continued

W
Facility Number:a —2-39Date of Inspection I�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:_
Designed Freeboard (in):_
Observed Freeboard (in): 2J�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
2fNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ICJ 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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
XNo
❑ 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
,(
2 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El�/J Yes
,,,___,,,(((
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
XYes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination., ❑ Yes
XNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA -
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
RA�/FzE�D s �0 7 I' sL 46G40 L✓ � ��
Reviewer/Inspector Name IPhone: 7'0/^ /T 7
Reviewer/Inspector Signature: _ _ _ __ _ _ Date: aL ali< _

d
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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the. facility fail to have an actively certified operator in charge?
❑ Yes
rrrVAAANo
No
❑ NA
❑ NE
/❑
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
91NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ YesX No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
[INA
[INE
and report the mortality rates that were higher than normal?
td
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
❑ NA
El 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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/VrNo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
LAT K'�/il?f�7dt157sFc� ©.✓ Sou / �51
21)
mo�o.""�
o r�SC*f C>OP ��3��05, l All,�sf (�, Feo yl Ce101
12128104

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Nate of Visit: Time: l
O Not Operational O Below Threshold
Permitted 6 Ce
(rtified
13 Conditionallyyp Certified 13 Registered Date Last Operated o`�rA1bo Threshold:
^ .
Farm Name: __._ e�lA l�EI�JC-�! 1__.. County:
Owner Name:
Maflmg Address:
Facility Contact: u Title:._�__�
Onsite Representative: �jLj
Phone No:
Phone No: / ,—
Integrator.
Certified Operator: _—___.__ .. ---_ Operator Certification Number.
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude =• = =- Longitude =• =' 0-
-Design
Swine ::CapacityXapadty
-Cm�t .,Y �� -= Desgn Gnnent -
Po nlahon y�4�hy`". .. Ca`aci :Po'tilahon, .Cattle __ `,,,Ca
De9gri Cnr�ent
aei Po elation
Wean to Feeder
❑ Layer
Dairy
Feeder to Finish
O
Q
❑Non -Layer
Non -Dairy
Farrow to Wean
��
Farrow to Feeder'
L z.
Total DestgnCapactty-
f Total smw -
Farrow to Finish
Gilts
Boars
Nmatier ofLagoons
P�
xN
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): �—
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ N
❑ Yes
❑ Yes
No
❑ Yes
[YNo
Structure 6
12112103 Continued

Facility NumbeDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes p No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWG
7. Do any of the structures need maintenance/improvement? ❑ Yes N
8. Does any part of the waste management system other than waste structures require maintenanceltmprovement? ❑ Yes No
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Q-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Fes evE LB) S a,6D 4(t Gs W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ___ ���
14. a) Does the facility lack adequate acreage for land application? ❑ Yes C N
b) Does the facility need a wettable acre determination? ❑ Yes 0o
c) This facility is pended for a wettable acre determination? ❑ Yes Q Nj
15. Does the receiving crop need improvement? ❑ Yes I N9N
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below []yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
2-3 ) be, wEAP& fit. 9Am6-L—r0G
35,E
t1 QbA-rr c 61 oP �sEL�
FaR
fbs t� kC�
LoP Y a-F Agduk, Wt-74
%
pfhp TEAR RA�►r� oil
fEsC,uE
1-PDA iE
W UP,
Reviewer/Inspector Name t=
Reviewer/Inspector Signature:
ninma
Date:
^--`--•-a

Facility Number I _ Date of Inspection
Renuired 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 appro ate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ffSoil 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 reviewlmspection 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?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rambreakets 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?
1
❑ Yes No
❑ Yves M/No
dyes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
El Yes
[rlYes
❑ Yes
❑ Yes
❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Vk
35. Does record keeping for ES required forms need improvement? If yes, check the appropriate box below. Yes
❑ Stocking Form =Crop YYiield/F�etm ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections Q'Annual Certification Form
U No
No
No
EA
L No
■
E3 No violations or deficiencies were noted daring this visit. You will receive no farther correspondence about this visit.
-�-
12112103

IType of Visit MY Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit O Routine O Complaint JWFollowup 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number /O Date of Visit: Time: -As
NotOperational OBelowThreshold
0 Permitted ❑ Certified 0 Co it* naUy Certified 0 Registered
!� Farm Name: 6 i fF ' h''" "Oe:g
Owner Name: eLz i /i yowl-z-
Mailing Address:
Date Last Operatedd Above Threshold: _
County: �/
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:RS�1Rl,..F
Certified Operator:
Operator Certification Number:
PC Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude =' =-
=-
-,Des,-
gD
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify
DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any pan of the operation?
[3 Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than
from a discharge?
❑ Yes
❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101
Continued
��Z

A
`f

Type of Visit '00 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit YdRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Time:
p� Not O erational Below Threshold
,r Permitted ❑ CCeerrtified 0 Condifionallv Certified D Registered Date Last OperatfAor Above Threshold:
Farm Name: 11E%>/� �Tfi /YI County: /�y�L�/✓
Owner Name: �%Zi fl 64,7c Phone No:
Mailing Address:
Facility Contact: Title: Phone No: �'
Onsite Representative: 6-2 4 T� Integrator: �PES7-;fne / /r.Pm S
Certified Operator:
Location of Farm:
Swine ❑ poultry
Swine -
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Operator Certification Number:
❑ Cattle ❑ Horse Latitude =• 0• =- Longitude =- =, 0-
Dischames & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes P�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
;jNo
❑ Yes
�l No
❑ Yes
;zfNo
Structure 6
Continued

Facility Number: —23 g Date of Inspection /O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes l4 No
❑Yes No
XYes ❑ No
❑ Yes No
❑ Yes Z No
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
11.
Is there evidence of over appl/t'��a+non? \ ❑/Excessive Ponding ❑PAN ❑ Hy lic Overload ��y
Cl
❑ Yes
'zNo
INo
12.
Crop type FL(t,/E / V.QRZF 1 . l ORd �O`�,�f� S RckwcE ?oros
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
XNo
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
)21 Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)zNo
21.
Did the facility fail to have a actively certified operator in charge?
WrYes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
����,,,,{{{{
(ie/ discharge, freeboard problems, over application)
❑ Yes
10 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
24.
Does facility require a follow-up visit by same agency?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
lam' No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gomments'(refer-to question #): E:plain any=YES sosveers•and/oi any,recommendations oranv othercomments:,>-,
.Use drawings of facfiityto bettei explain situations: (osesdditionalpages as necessary):" ❑ Field Conv ❑ Final Notes i .
EED o fyko(z_f;i� ` rFrEp. AREA, ®E SNAqF
ERopQ,�c �E><t Laaoot�, tJEE9 STu�Q,ZF_ RRFFi T'o
O
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T�ECoQpS COPq �� S.lRF
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t�+%H
(C JEn)�i MA,%<E RACF,ZG.r* /JAE f�
Reviewer/Inspector Name Z
Reviewer/Inspector Signature: Date: O 2! 42a
05103101 yr --- --
Continued
UFp

Facility Number: — Date of Inspection / pZ
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there anv dead animals not disposed of properly within 24 hours?
El Yes
28.
Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
rrr�yyyNo
t,p No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
VrNo
31.
Do the animals feed storage bins fail to have appropriate cover-
❑ Yes
; No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Aaaruonat ,—omments:anmoruraaemgs:-
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05103101

Facility Number: _ —,�„ _.9 Date of Inspection: b D
I AddiboaalComments-and/or DraWings .
27) r DLLDUI - UP UZ5Z7 %UGEOE/J �F�A�f�i� d'F L NEED
LSSt1Es, l��GL /Ri� /o GZ^�E 4b Atl
-LG V06
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13Z0-1 &00
4/30/97

�' �` Q Division of SoB and Water Coaserva4on
Type of Visa Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit: 'a-"'U Time: d 3 O
Q Not Operational O Below Threshold
Permitted [3 Ceerrttifi'ed1 [3 Conditionally Certified 0 Registered Date Last Operatkil or Above Threshold: ............. _..........
FarmName: ........YS t7 ..1.............................................................................. County: ...... ,/D r.. �/).!:1...........t........_.......... ..... ...............
OwnerName:_......................................................................................................................... Phone No: 1.G. .. db� � / 3 l �
Facility Contact:...............p.....:.......`.../.../...................................... Title:
Mailing Address: ..1..Q.._.R.�._.1.7..G ...........
Onsite Representative: (asqt�...............................................
Certified Operator: ................................................... ...................................
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F__j• =, =,. Longitude =• 0, =­
Design_- Current Design Current Design Cdrrmt`"
Capacity Population Poultry Capacity Po ulation Cattle Capacity Po pulation-�
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish q O ❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean '
❑ Farrow to Feeder 10Other .. _
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons : - ❑Subsurface Drains Present 101,agoonArea JOSprayField Area
Holding Ponds? Solid Traps'_ E== ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.................................................................
...................../................................................................................................................................
Freeboard (inches): �7
5/00 Continued on back

Facility Number:,-;( — QQ)r I Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
WNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
KNo
closure plan?
❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
y
,J�y Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
[]Yes
h'No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
ff No
elevation markings?
❑
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
% No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal
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?
Management Plan (CAWMP)?
❑ Yes XNo
❑ Yes ,KNo
❑ Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
WYes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
XYes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
D(Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
Q Yes
O(NIQ4-
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P4 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IX No
24.
Does facility require a follow-up visit by same agency?
9Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
(Vq.00ria(io"S;o dgficiencies -were itgCe(1• iljt649 thisAwit; • Yop will-Sec$iye 40 fujt�tgr ;
6 itzsoorideitce: abbot his visit: :::::::........................ •.:: :
s of facility to better explain sitatations.`(use additional:vues as necessary): _
�IS �e t 'S� ati �h�� ill �y c�t�
Ap_a'As , ��� "�X �Ji �k'L; cic6e �„ e4e� 3 stow LA
L-'4k r-e sue( i-21 A-L\ bG k cn'
-1 Sid tiaesr3 r2—g 5� did A CrJV,Q2—, � ��t .e� Iikvi-/ e,141
Reviewer/Inspector Name ;,
Signature: \���J, ��® n, Date: 5/00

Facility Number. - —�,'1� Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
AYes ❑ No
[]Yes MNo
❑ Yes E] No
❑ Yes VNo
[]Yes t6 No
❑ Yes plc No
❑ Yes RrNo
n tioa ; omments an or_ Drawings:
_ .lot
11
�s/ �-eSC �-�`� �`'� ovel�� t,..`-� �s Il.-• ��Q �. � \C�.3i
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V-0, ��. rr"" ipi__��zi
s.
.

Facility Number.' — a, g Date of Inspection Z O
UA
t;'A
l STi +e �K v e )io
l�() ire4 � " ujpaj�- L,
ASS
k J� w
7/25/97

m Division of Water Quality
p Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit kRoutine O Complaint kFollow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number
Printed on: 10/26/2000
Permitted E3 Cerrtified� 3 Conditionally Certified 0 Registered Date Last Operated
door Above
Threshold: ...
..................
....
Farm Name: ..........I�_Q:... Y.V..�:...........�:iL, .... ..:........................ County: ......... 5.(... /,/f..4..........
Y, a -I I G .%.�.................................
Owner Name :........ ..^.....11..1...k'.Ll............ ....... .d!:'K......................................... Phone No:....r:/..�V..S,r1.........2 T...�7...........
Facility Contact:
Title:
Phone No:
Mailing Address: ._J33.......... YR .....y ....YV�. .....�'�P.S.._:.... ..._L.'..........Si.��.i_%.:��j.,.�.,�,",......L.Y.. .... .... fJ.t,1..6..?r
OnsiteRepresentative: ........................................................................................................... Integrator:............(. r�.:�.!."'�1..�............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• Longitude =•
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds/ Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present 1LU Lagoon Area
No Liquid Waste Management System
Discharges & Stream Impactti
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated Bow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
u
Identi tier : .............�............. .................................... ................................... ............... ..................... ..:
..........................
Freeboard (inches):
5100
❑ Yes [$No
❑ Yes ❑ No
❑ Yes ❑ No
Al1Q -
❑ Yes ❑ No
❑ Yes I�No
❑ Yes RNo
❑ Yes 00
Structure 6
Continued on back

Facility Number: + —L3 Date of Inspection /� G /S/py% Printed on: 7/21/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNo
seepage, etc.)
-
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
P(No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
;<No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
�/
12YYes
!❑
❑ No
11.
Is there evidence of ver application? Excessi a Ponding ❑ PAN ❑ Hydraulic Overload
Yes
�No
12.
r❑
Crop type (S %l.t �- 1
13. Do the receiving crops differ with those designated in the Certified
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?
Waste Management Plan (CAWMP)?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
U' N,6.*iolatidris'oi•. dt- icienciM were itofed during tbis;visit* - Ybu will-t&e iye inn; futthl, • ;
. • . • cori esnondence: abouf this :visit ::: :
❑Yes VNo
❑ Yes �No
❑ Yes P(No
❑ Yes XNo
XYes ❑ No
❑Yes No
❑ Yes XNo
39Yes ❑ No
P<Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 'A No
XYes ❑ No
AYes ❑ No
////"")(Yes ❑ No
to question #): Explain any YES answers and/or any recommendations or other comments.
acuity to better explain sitoations. (use additional pages as necessary):. M
f�,� is a Y ov�v�.t..' -�o ►�a rv- u..� 5 i I•c, v,� i+.
0[V it l o. hcw�t� rt-,��d— v�� pla n• w �lw �
yv �4abl c a �-4-°W6V i %° wt t d_ -►D lc.4.t - -� rms
D C cwa� �D ptA� NaS� Vl rl �I Lv t+ �aNl ��i L� 0.t rt AAOS
v�.-IW i
Yt/k N4 a� 6tk,,- a:.w;,-a.,Q vwwp s�.ow wrc�Ilct..�s,F;dlnLs iY�S°dc�
Reviewer/Inspector Name /� . 1 t 6{ r I V w (, W �.-O) f D�J 3 a►$
Reviewer/Inspector Signature: It i?" _ _ Date:
i

( Taciliry Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge SJor below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation? __ \\
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JQNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes r3d.No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes PLNO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes PNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
Vrv� ru.d -Iv I�,,M. ap Q); c.�11s�•.— w�l�.-� 5
t�
o L�"
`"' CAu�IAV
l�1 F-csft...c. �rrp
J1 � d- Il�t,,na.al. t.Jti.w.
aotolc.al, -�v.— �a I l
i �,7U v,,,4k a tw-j4- C'O' l wJ t'r't$4 ' . m01 i� t rr,
5/00

Facility Number 3 I I Date of Inspection L`} )-_a
Time of Inspection []= 24 hr. (hh:mm)
Permitted Ceerrtiified E3 CoonnLionally Certified 0 Registered 0 Not O erational Date Last Operated: ..............
Farm Name: ..........Y��'l._`..5..................................................................... County: ............ ^!...1...................... ..........
.
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ................................................................................. ......
Onstte Representative: �4. ��.1' ' ' `:�
..................................... ................... ..........................
Integrator:.........
,,�j_�!skjq ..................
.....................
Certified Operator: ................................................... .............................................................
Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =" Longitude =•=' ="
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gad/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 . Structure 6
Identifier:
Freeboard(inches): .............��........... .................................... ................................... .................................... .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O-No
seepage, etc.)
3/23/99 Continued on back

Facility Number: �3 38 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? •
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidencA of over
12. Crop type
❑ Excessive Ponding ❑ PAN
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
W. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.... •yiol....s..... c..... were ..... itig this:v. I • Y:oit ..1.. eceiye t.. f.. I. er . .
corresaoridence: abo»t this :visit: � ::::: ::::
Use drawings oGfacilitylo hefte-r;explain situations (use additio
Li
r`t, Spy gyad •t- � �y�..sE, f
Reviewer/Inspector Name
5f W a. Vvu4 ,e
}-ed • Sc•Y �e41.s �� p�
❑ Yes WNo
❑ Yes XNo
❑ Yes XNo
•(Yes ❑ No
❑ Yes J. rNo
❑ Yes �(No
Ryes ❑ No
❑ Yes J( No
XYes ❑ No
❑ Yes ❑ No
❑ Yes PfNo
❑ Yes KNo
❑ Yes 19No
❑ Yes WNo
❑ Yes ❑ No
❑ Yes 'VON(No
❑ Yes KNo
❑ Yes D(No
❑ Yes kNo
❑ Yes "KNo
❑ Yes 21-k-N' o
0 SS /s?z7__4FA
Reviewer/Inspector Signature:
Date:
n_�n

` Facility Number. Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes p[J No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
IN No
roads, building structure, and/or public property)7�`
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
RNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
[�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
0�I0
H
�aL i'-�• t �T6-
lwt,��IGt-.
� � ���� st-�+�e�; �� het-�c�', �ee�✓✓-(a__

10 Routine p t-omptamt p ronow-up of uwtl inspection p ronow-up or uawa- review 0 vtner
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
p Permitted E Certified p Conditionally Certified p Registered in Not Operational I Date Last Operated:
Farm Name: Mth.Pate.F.arm........................................................................................... County: Duplin WiRO
Owner Name: Keith ....................................... Pate ............................................................. Phone No:4919.).6511n5.495 .......................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:
Mailing Address: 14119.NC.Hwy 403...W..est................................................................... Mount.O.live..N.C................................................. 28365 ..............
Onsite Representative:
Integrator: Pr atage.F.arms.....................................................
Certified Operator:Marshall.&........................ Fate .................................................... Operator Certification Number: 1fl125.............................
Location of Farm:
Latitude Longitude ®• ®' ®"
1 2,940 U
1. Is any discharge observed from any part of the operation? p Yes p No
Discharge originated at: p Lagoon ❑ Spray Field p Other
a. If discharge is observed, was the conveyance man-made? 13 Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? p Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway 13 Yes 13 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..............29...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, f] Yes p No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31-238 Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
p Yes
p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
p Yes
p No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
p No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
13 No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
p Yes
p No
11.
Is there evidence of over application? [3 Excessive Ponding p PAN
f] Yes
p No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p Yes
p No
14.
a) Does the facility lack adequate acreage for land application?
p Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
13 Yes
p No
15.
Does the receiving crop need improvement?
p Yes
p No
16.
Is there a lack of adequate waste application equipment?
p Yes
p No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ "P, checklists, design, maps, etc.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
13 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
p No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
A- No.violations•or. deficiencies.were•noted-during.thisvisit.-Yatrwillreceivenofurther-.-
... .. ... .... .. ..... .................
.correspotideuce a oitt this:visit:
Name
Reviewer/Inspector Signature:

10 nounne p %_ompramr p ronow-up or tuwv inspection p ronow-up or u�,wc review 0 vtner
Facility Number
Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
p Permitted E Certified p Conditionally Certified p Registered
in Not OperationalDate Last Operated:
Farm Name: Keith.Pate.Earm...........................................................................................
County: Duplin WiRO
Owner Name: Keith ....................................... Pale .............................................................
Phone No:(9.19).6511-.5495 .......................................................
FacilityContact: ...............................................................................Title:...............................................................
Phone No:....................................................
Mailing Address: 14119.NC.HwyA03.. icst...................................................................
Mount.Ofte..1V.C................................................. 28.165 ..............
Onsite Representative: ..........................................................................................................
Integrator: Pirfstage.Earna .....................................................
Certified Operator: MarshaILK......................... Pate ....................................................
Operator Certification Number: IR125.............................
Location of Farm:
Latitude ©•®' ©� Longitude ®• ®' ®"
Swore
= esign urgent; e,._urrent esign urgent m
=CapacitytiPopulai Poultry Capacity Population tittle T CeP C- Populshon_}
13 Wean to Feeder
= p Layer = O Dairy I-z
�-
-. p on- ayer _ Non —Davy
® •tie er to ma
= —
p arrow to Wean
p arrow to ee er
p Other
p Farrow to Finis
_ - Total Design Capacity 2,940
Total SSLW 396,900
p Gilts
❑ Boars
Subsurface rams resen Lagoon Area Spray FieldArea
``" Number of Lagoons 0O g 0 P Y
Holding Ponds / So dh Traps _� p o Liquid Wa-sTe-ManagementSystem--
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? 13Yes O No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) f] Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 13 Yes D No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ...............29...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
p Yes p No
Continued on back

Facility Number: 31-238 1 Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
p Yes
p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
p Yes
p No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
p No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
p No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
p No
11.
Is there evidence of over application? p Excessive Ponding p PAN
p Yes
p No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p Yes
p No
14.
a) Does the facility lack adequate acreage for land application?
13 Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
13 Yes
p No
15.
Does the receiving crop need improvement?
p Yes
p No
16.
Is there a lack of adequate waste application equipment?
p Yes
p No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
13 Yes
13 No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? p Yes p No

s E3 Division of Sod and Water Conservation Operation Review h s
Division of Sod and Water Conservation Compliance Inspection
Division of Water Quality_. Compliance Inspection
0 Other Agency 'Operation Review s
I Facility Number I
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
[3 Permitted Wertified 0 Conditionally Certified 0 Registered 0 Not Operational Date Last Operated:
Farm Name: .....
County:......;....`.:` 1. h
OwnerName: _ F " ��T.............................................................................. Phone No: ............... ................................................................
FacilityContact:.............................................................................Title:............................................................... Phone No:...................................................
Mailing Address:. .n.....1.r�.. _�G"._`!.".................. S.y.\A.._�_5.1�2t. �1.�.......3.. ............................ ..........................
Onsile Representative:... ".. , .... Integrator:......... _, �
..................... ..........................................................................................................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Latitude Longitude =• =' =-
- Design Current,
Swine Capacity Population F
❑ Wean to Feeder
Feeder To Finish
7710
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Holding Ponds / Solid Traps
Design' I;. Current ,'.' Design . Current
❑ Other
Total Design Capacity
Total-SSLW
10 Subsurface Drains Present 110 Lagoon Area I❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ElLagoon [ISpray Field [IOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [,NNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5. Structure 6
Identifier:
Freeboard(inches): ......... , 7'i...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: -: 3 Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
,,,vvv---...!!! �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
XYes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�dNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
]'No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
t4No
11.
Is there evidence f over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
NfNo
12.
Crop type esc.nR
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
C�No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
,XYes
❑ No
16.
Is there a lack of adequate waste application equipment?
Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
tgNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
PTNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
jNrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
gNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
24. Does facility require a follow-up visit by same agency?
❑ Yes
1� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
(Yes
❑ No
�' dVti yiolafiotis:oi &ficiencies *i re noted diWiitd tbis:visit; You will i eceiye Rio: further: •
corres ondeit& abbuE this :visit: ::::::::::::::::::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations`or any other comments
Use drawings of facdity tobetter explain"situation.-(use additional pages as nee' ssary)-=
_
ets�Cald -�e �� e
Reviewer/InspectorName ( --
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: 3 -9-3 ,W Date of Inspection-c+-F-�-�.. ,
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes FXNo
Additional Comments and/or Drawmgs: - . - ' ,. -
19) �eIQI� eQ iz CL� e- G1L- s[ s/ / 1.
Ir�^i� �G ��J o� �� off_ ✓��. ��v � (-�G F �% �
t ?t—1,S app�Yl G� fGfi'� lrl ��yy �<t�
�rcc tr .1 �2 l5 lin e )9? [tick, I^ kis GL-t-- 1t., cti Yl�� � �prel
a1�a �►�j loci s�.r�ttiet.- c t-cps �sz�
`L t" Orz f d t-hi `���i �, S' N I -F-
G of elr s�-�ot.1�, �L'"k tT`� ckI \A
-esCL-e � � �
Sjor; � aG0O,� S�,.l�5i� c�lz tac�tlp�is�Q� r`h�sr��,
�J
3/23/99

(Type of Visit O Compliance Inspection OO Operation Review O Lagoon Evaluation I
Reason for Visit OO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number j
Date of Visit: 12/28/2001 Time:
10 Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: Keitl>.Yats.Far ia.......................................................................................... County: I)mplia................................................ X. jRQ..........
OwnerName: Kei111............. A......................... rae .............................................................. Phone No: 91Q-2.676.5.7.d...........................................................
Mailing Address: d ..Rate.XA.Ixd.Y�'.R&t.......................................................................... UQUat..Qumc...NC................................................ 28 65..............
FacilityContact............................................................................... Title:................................................................ Phone No:
Onsite Representative: YxRtd..K.atf:.................................................................................... Integrator: l'iwage.F',arms.....................................................
Certified Operator:Cb.Cis....................................... CQUIC ................................................ Operator Certification Number:2.2006.............................
Location of Farm:
East of Faison. At the end of SR 1357 South of SR 1306 near Beautancus.
® Swine El Poultry [3 Cattle ❑ Horse Latitude 35 • 06 33 Longitude 78 • 03 02 -
Swine
Design Current
Capacity Population
❑ Wean to Feeder
® Feeder to Finish
2940
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design ' _Current Design
`Capacity Punulatitm -.Cattle Capacity-
❑ Other
Total Design Capacity. 2,940
Total SSLW. 396,900
Number. of Lagoons:- 0 = ❑Subsurface Drains Present ❑Lagoon Area ❑
Holding -Ponds / Sofid Traps "� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure 6
Identifier: ....................
Freeboard (inches): 32
05103101
Continued

,
Facility Number: 31-238 Date of Inspection 12/28/2001
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
N No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
N No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
N No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12.
Crop type Fescue (Hay) Com, Soybeans, Wheat Fall -Spring Veg.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_
Comments (refer to question #) Eiplam anysYES answers and/or _a=n`y�recommendahonsior any -other cowmen_ is
.Use -drawings-(if facility --Co better ezplam srtuahons (use addrttonal pages as necessary) ❑Field Co ❑ Final Notes
P py
" Improvements have been made on issues of concern by DWQ. Mr. Pate has a OIC (Chris Cottle-22006), Wettable Acre Detemination
completed by Kraig Westerbeek ( I did not look over it throughly), New General Permit and CoC on site, A new aria] photo, and his
Front Fescue field looks improved.
Reviewer/Inspector Name Patrick Fussell - _ =
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: 31-238 Date of Inspection 12/28/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during.land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes []No
05103101

Facility Number Date of Inspection
[Time of Inspection E= 24 hr. (hh:mm)
p Permitted 0 Certified p Conditionally Certified p Registered of peratmna Date Last Operated:
Farm Name: Keith.Paie.Farm........................................................................................... County: Duplin WiRO
OwnerName: Keith ....................................... PAIC ............................................................. Phone No:(919.)..658-5495 .......................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address: 14tt9.NC.Hw.y_403_Wes1 ................................................................... MouuLDlive..N.C................................................. 28365 ..............
Onsite Representative: .......................................................................................................... Integrator:Prestage.Earms .....................................................
Certified Operator:Marshall.K_........................ pate .................................................... Operator Certification Number: 18125.............................
Location of Farm:
Latitude ©• ®' ©" Longitude ®• ®' ®"
-Design ' Current ¢sign -Current - esign- urrent '
-Swine -Capacity_Populatiou_ spoultry_ Ca_pactty Population Cattle Capacity Population`
p Wean to Feeder
10
Layer
❑ Dairy
® ee er to ims
❑ on- ayer ❑ on -Dairy,
10 Other
Total Desigm-Capacity 2,940
Total SSLW 396,900
❑ Farrow to can'-
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
�=
Number oC+Lagoons ❑Subsurface rams resent ❑ Lagoon Area ❑ pray Held Area
Holdmg_Ponds / Sohd Trapsy0 = ❑ o ..aqm Waste anagement ystem...
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? - ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes []No
c. If discharge is observed, what is the estimated flow in-aUtoin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes []No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............2..9...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes p No
seepage, etc.)
3/23/99 Continued an back

Facility Number: 31-238 Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
p No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
p No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
p No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
p No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
p No
11.
Is there evidence of over application? ❑ Excessive Ponding p PAN
p Yes
p No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
p No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
❑ Yes
p No
15.
Does the receiving crop need improvement?
❑ Yes
p No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
p No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
p No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified A WMP?
p Yes
p No
Lt'IN,o.vlotatlons'ot''u6Ictetfetes-Wet'e'tloteu'a'upng.tilts vlsgt - Y q'ir R711'ree'elve no IUYtne1:'-'
corresnonden e. abbitt this:visit.
dike wall has very good grass cover. No immediate threats where observed.
Reviewer/Inspector Name Stonewall Mathis - Tim Holland (DLQ) ,
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation E3 Other Agency
Division of Water Quality
IQ Routine U Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review p Other
Date of Inspection G _l 8
Facility Number `3 2,3 8
Time of Inspection = 24 he (hh:mm)
E3 Registered 17Certified 13 Applied for Permit 0 Permitted [3 Not Operational Date Last Operated: ..........................
FarmName:.. ......................................................... County: ....... ....`\..`\............................ .......................
Owner Name:.................................. �i......................................................................... Phone No: ... .....1..�•..._ ,6v1���'I
..... .
FacilityContact: ..................C.............t.................1............................... Title: ................................................................ Phone No:...................................................
Mailing Address:.... �'3....1..... 1��.....5�-�..-1G3..._�........ �£.\1..:_d�\v2.....�\-J-9-3C5................................ ....... ........
OnsiteRepresentative:_..`J.�_`..._'1`\`�.....0 e .............. Integrator:..._ e....._5......1` `T...................
Certified Operator:............................................................................................................... Operator Certification
Latitude =•='=11 Longitude =•='="
General
1. Are there any buffers that need maintenancelimprovement? 01Yes ❑ No
2. Is any discharge observed from any pan of the operation? ❑ Yes IR No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes i(No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes i No
c. If discharge is observed, what is the estimated flow in pUmin? _
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes trt,NO
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes % No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ONo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes *o
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes N No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes *o
Structures (Laeoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? (Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ....................n........ ............................................................................................................
Freeboard(ft):..................... SL.. ......................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
(9 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
[x Yes
[],No
12.
Do any of the structures need maintenancelimprovement?
KYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
W No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
P�No
(If in excess o WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type to ..... r..1' t.............................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
allo
18.
Does the receiving crop need improvement?
% Yes
❑ No
19.
Is there a lack of available waste application equipment?
Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
MYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
22.
Does record keeping need improvement?
9Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
�(No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
KYes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
P4 No
0
No.violatiom-or deficiencies:werenoted during this:visit: Yot14ill ireceiven&ftirther:
correspbndehceahoutthis:visit::•::.:
\�Gc�� ��L_"1r-_�.7I}•�1 I\\
L{ t � �c I� / Ion �(� / tZL"T�
��v��\cam a•�-e.z4,e�.` S�e-ep sCaq v�.ex
7/25/97
Reviewer/Inspector Name im
Reviewer/Inspector Signature: _r_1 Date: W179118

Division of Soil and Water Conservation [3Other Agency
® Division of Water Quality
11BRoutine O Complaint 0 Follow-up of DW`Q inspection V Follow-up of DSWC review V Other
Date of Inspection
Facility Number �1111••1—„'—s�
Time of Inspection 0 24 hr. (hh:mm)
D Registered ® Certified 0 Applied for Permit [3Permitted JE3 Not Operational I Date Last Operated:
Farm Name.... t.�. ..... pa..f:t,........1F^:.................................................... County: .....a?.tt.�.L v.................................. .Ut..F-
OwnerName: ....................... ...... ..................................................... Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:................................................................ Phone
'No:C9.1.9�..6....�....-._s..y..9 S
NfailittgAddress: .... 1_fl3....P�......... t�1.-..._S ^ ? r.._S '�. ................. .i...t........0..�. Y._R.'........N..� r..................... �..�.b.s
Onsite Representative: ... .�r..-. 1.. .......pRSJ ...................................................... Integrator: ... ..Y.:.C.:S_'IP-A.P . . .............................................
Certified Operator:............................................................................................................... Operator Certification Number;.........................................
Location of Farm:
Latitude 0• 0' =" Longitude 0• 0' ="
Design -- _Current- Design Curren6 . = Destgnc Current ,, ;
Swine Capa©W,,Population Poultry •�94acity?Population Cattle a Capacity Population,;`
t; ❑ Wean to Feeder I0 Layer I ❑ Dairy �.
❑ Feeder to Finish I0 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder = ❑ Other'
❑ Farrow to Finish Total Design Capacity; "
❑ Gilts r ;,J
T
❑ soars „ Total SSLW
Number of Lagoons! Ilolding:Ponds E ❑ Subsurface Drains Present ❑ Lagoon Area, ❑ Spray Field Area
v
w ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than laeoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes RNo
❑ Yes &No
❑ Yes
® No
❑
No
�Yes �ARI
T
❑ Yes
1R No
❑ Yes
19 No
❑ Yes 2 No
2 Yes ❑ No
❑ Yes ® No
❑ Yes Q1.No
Continued on back

Facility Number: 31 —2-2X I
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
29 No
Structures (LaQoons.Holdine Ponds. Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ...._2 . 1
Freeboard(ft):..................................... .................................... ................................... ............... ..................... .................................... .....................
..............
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed? -
i YYes
❑ No
12.
Do any of the structures need maintenance/improvement?
'Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
19No
Waste Application -
14.
Is there physical evidence of over application?
❑ Yes
)ENO
(If in excess ofWMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..... t 3 .4_........................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
®.Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
EgNo
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O No
22.
Does record keeping need improvement?
❑ Yes
ONo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E'NO
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
B-No
No.violatioitsor &ricieitcfes. were noted during this.visit. You. 0 receive no ftirthei-.
eorrespondenceab'outthis:visit:
5. F tG v J-q_ GJ v w.. W v w J`v' i 0. i'i 0 w t p i h. SO �1 0 i vi 't-S d-O L-C.t
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Po-p1 Gi 11yt torvE-Lt e 0Si0 t SLepaT bet/dc k4ufA-f 0-�4
c o t re w 0. d ry i "'�-� a
L t c {r +,,r- f c e5d 19.Wc.li Oin V. rid a� VOfUK sPeci irs �eScvti
Re co .o,-S 100 OUrt
A LL 4 t gA_ t i 4rn ty vi l) {o a S 4,� t ia_ o j; O � a l p� V 0 w a 117/25/97
Reviewer/Inspector Name 4
.e.-
Reviewer/Inspector Signature: ti,A _0 _, - __,,M _ . jj p I „�,. _ _ _ � Date: