820427_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: Q"Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Dunne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: CountyARegion: �y
Farm Name:_�e , a , g- �Q.fiYL� Owner Email: '��J"��
Owner Name: ���/~�/p�� ���f l Phone:
Mailing Address:
Physical Address:
Facility Contact: 6T r+e-1- I&Ary e Title: ZPe,J,41i x-i Phone:
Onsite Representative: , --;%, '.'� Integrator:
Certified Operator: iP� 411 pr-/f __ Certification Number: '/ 9,-/
Back-up Operator:
Certification Number:
Location of Farm: Latitude., Longitude:
Design Gtnmm
Design
Current
Design
Current
Swine Capacity
Pop,
Wet Poulltry
Capacity
Pop.
Cattle Capacity
POp.
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
Non -Laver
Dairy Calf
Feeder to Finish D
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Jiro it
Po
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Al
10ther
ll Irl i i 11.1111 feYwPyl9lxlnw,
WMs
11
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any pan 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 [�J o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
[] No
❑ Yes
❑ Yes
�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

lFacHity Number: - Date of Inspection: y
;Waste Collection & Treatment
' 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[?I/No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
TNo
D NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FTNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E j- 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 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
fo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[r]'�lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L_ I lq
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'1 Imo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[n No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need im vement? If yes, check the appropriate box below. �es No DNA ❑ NE
❑Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�!No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: ZIP
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F�!f 'No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
En 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 E] 'N.
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes L.J No
❑ 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 I_J o
❑ Yes ErNo
❑ Yes El"No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use Comments
s of faciliarst�o better e p y nns (use ad pies as necessary).ions ar any other comments. ( q Explain an YES answers and/or an additional_recornmenda
h ty x lain sitvati i ( difional �
Ye
tea; l/IPu
r 1Y;D11,
I Iz�e6ore!V
f
Cl.n tCA tL r f L [ .5 � ?— C�-•#Ssoi 1 r ��r t� �l �.� iS
Reviewer/Inspector Name:
Reviewer/inspector Sigriatur
Date: b
21412015
Page 3 of 3

1
K.
Type of Visit: EMompl' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Or Routine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: r Arrival Time: o Departure Time: pp County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �2f ram —per r-r— Title:
Onsite Representative:
Certified Operator: v' U
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design GORR
Design Current
Design Current
Swine Capacity op.
Wet3Povltry�i Capacity �+Pop'
IS
Catfie Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
17'e—eder to Finish
o
IID
Dai Heifer
Farrow to Wean
Dry Cow
Design
Current
Farrow to Feeder
Dr. P,oul
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
0iheri ,; t
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes JERNo ❑ NA ❑ NE
❑ Ycs [:]No ❑ NA [:]NE
❑ Yes ❑ No ❑ NA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Ycs ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EjNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Ycs No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3 1t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Eg_No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
0—Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ N E
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
® Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(I No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C2�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 Approved Area
12_ Crop Type(s): �t�'m, 1 fp,�� Apll � el
13_ Soil Type(s): W.-
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
Callo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
®.No
❑ NA
❑ NE
acres determination?
IT
Does the facility lack adequate acreage for land application?
❑ Yes
[UNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ER[ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
M No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JR[No [] NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection:
k. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes &I No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [qNo ❑ NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [K 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 54'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 N 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 N 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 E�j No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ER No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,E�LNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comment&
Use drawings of facility to better explain,situations (use additional pages as necessary).
�Y�wlf� j?CC/E7tvrd✓ /!� �%— j %
Yd D:�c r
l5 cr�uri d &r'r 74-
74 U
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Phone: (
Date: /P
21412015
Page 3 of 3

'- hod- rv/G• SSG_
^ '-ion of Water Resources
Facility Nnml►er - ® Q Division of Soil and Water Conservation
- � Other Agency
Type of Visit: Q,Comptjance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint C) Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: � Arrival Time: 'po Departure Time: ,' 3 a County: fir__ Region: E v
Farm Name: � s t'[ /�w7 .4 r►,,-
-r
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 6 r rr-0-- 1Wy)d-r-r_ Title: Phone: L
Onsite Representative: �,�•-e� _ _ Integrator: f
Certified Operator: ,�r.,�,lyp zA 4C ,�,�// Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swtne' Capac>Pop.
Wet Pou
a ac!
I IGattle Capacity Pop.
Wean to Finish
[layer
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
[Non -Layer
Feeder to Finish
10
/ C'7
_ ,. „ ,:- , ....
Farrow to Wean
D Poultr
Design
Ca aci
Current
Po
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- Turkeys
Turkey Poults
Other
10ther
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 g�_No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. WhaI is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

FaciliNumber: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ES -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Elo
❑ 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
fS No
[:]'NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pg..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
E3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2!-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 > I0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) 17f11 ! �� D �K-11
13. Soil Type(s): y�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C. No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U�No ❑ NA ❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
tZ-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfaIl ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [] Monthly and V Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes [!�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes S No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: d--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ .1 o ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C!�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes E�No ❑ NA ❑ NE
[] Yes P5CNo ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes -EJ No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ER No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes &4No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 21 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes _tD-No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/lnspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: S
Date:
21412015

'VT 3 : - f G
Type of Visit: (fCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other <D Denied Access
Date of Visit: Arrival Time: ' 3 D Departure Time; �c7 County: Region: j:'i i
Farm Name - fj�D g Fa 1 rt­ Owner Email:
--o
Owner Name: r—� [�} r� (� _ jpt- f l Phone:
Mailing Address:
Physical Address:
Facility Contact. ter- << % 17 Q2-'r Title:
Phone:
Onsite Representative: aY Integrator;
Certified Operator: ,/ pO{ �C s/i� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design @> renf
Design Current
Design Current
: Swine -
Capacity Pope^
Wet Poultry
Capacity .Pop.
@ame Capacity Pop_
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
X-Feedcrto
Finish
Farrow to Wean
Farrow to Feeder
/,;�G/p M
R
Dr. ;Paul _
Design Guirent
Ga aci Po
DairyFleifer
Dry Cow
Non -Da'
Farrow to Finish
Gilts
Boars
'y
�'.-
La ersI
Non -La ers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
T
Other
`''''
TurkSX Poults
Other
Other
Discharges and Stream Impact
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 allo ❑ NA ❑ NE
0 Yes ❑ No D NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[—]Yes
[—]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
allo
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FacHity Number: - ;;Z IDate of Inspection*
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): c j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes [n No ❑ NA ❑ N E
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
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
[SNo
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RI No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Eg_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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): :-�`fYicCr�Q /04,1re
13. Soil Type(s): ..... /
14_ Do the receiving crops diffet1from those designated in the CAWMP?
❑ Yes
E&No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑.No
0 NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2No
❑ NA
❑ NE
acres determination?
IT
Does the facility lack adequate acreage for land application?
❑ Yes
5. No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
3No
❑ 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 [B.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall 0 Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®.No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21417014 Continued

Facili Number: jDate of Inspection: 1� /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (a No Q NA ❑ NE
V. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3-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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes -E; No ❑ NA [] NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes Callo
[-]Yes allo
[:]Yes Wo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendation_ s or any other comments.
Use drawings of facility to better egniain situations (use additional naees as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: /% 33CA-
Date:
21412014
Page 3 of 3

Type of Visit: Q'Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: tine 0 Complaint O Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: , t)O I Departure Time: c"� County;���,��
Farm Name _1_i„— !% Fd." ram • Owner Email:
Owner Name:r7/h.ta p �`� �S �� Phone:
Mailing Address:
Region: ,Fgo
Physical Address:
Facility Contact: ' r�T-� ^o r Title: Phone:
Onsite Representative: ,e —y Integrator:
Certified: Operator: d?Ct A,, ew-a K .S�pt / / Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current + Design Current Design Current
Swine Capacity • Pop. etW. Ultr} ,Capacrt Pope ° Cattle Capacity Pop.
Wean to Finish Layer - DairyCow
Wean to Feeder Non -Layer Dairyam Calf
Feeder to Finish (� ,�E ;. ' DairyHeifer
Farrow to Wean ` _ F.L. Design Vii Cow
Farrow to Feeder �:D �oulGa ace ?I. Po Non -Dairy
Farrow to Finish - Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Broad Cow
t Turke s ,.
Other TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge`?
❑ Yes n No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
f@No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection 7`/3 -/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:)Yes
D4,No
❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
0 NE
Structure I Structure!2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L.c'fr
Spillway?:
Designed Freeboard (in): f 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[n 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
[ANo
❑ 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 die permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
'® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [3 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): . _.' r3 ti__ --
13. Soil Type(s): Gfi,
14. Do the receiving crops difrer from those designated in the CAWMP?
❑ Yes
a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1101 No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
K No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
L3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rt"No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [—]Maps E] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,Tgl:No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -0 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,U� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

iFacili Number: - Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA W MP?
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 R No ❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes m No
❑ Yes No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations or any other comments -
Use d.rawints of facility to better caDlaln situations (use additional Dasxes as necessarv).
I <c e--o S � � v ��t� �• / C� �� r � �
J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: V Compli nee Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint p Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: f 98L=_ Region:
Farm Name: 61) 2:-
T � 7
Owner Name: P_/'Wnn j
Mailing Address:
Physical Address:
Facility Contact: (:& drYr / �"�— Title: c
Onsite Representative:
Certified Operator: Sl1
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: jyljj.J3/is�.
Certification ]Number:
Certification Number:
Longitude:
b
k t I
Des n Cur>1ent _ Design Current
Design Current
Swine Ca ac P,o Wet l?o
4 p tyy, p. ultry Capactt}° , Pop..
Cattle Capacity Pop.
We Finish
f a er
DairyCow
Feeder
Layer
DairyCalf
o Finish
DairyHeifer
Design:Cur nt, _
Cow
to Feeder
�D • 1'oW Capactty ''Po _
Non -Dairy
to Finish
La ers
Beef Stocker
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turkeys
,.
Turkey Poults
Other __
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Uallo ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
[—]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
ZLNo
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 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
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �s
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
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
4FUI U No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P!o
❑ 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): �cr�i YYd
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ 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
U 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
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[S No
❑ NA
❑ NE
Page 2 of 3
214120I1 Continued

Facili Number: f5ite of Inspection: — J
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes jZ No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5& No E] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 .g No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes DgNo ❑ NA ❑ NE
❑ Yes 'Eg No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or anyother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2ZIP �3S .33�
Dale: �-41 (�
21412011

N u ,V
rvision of Water Quality - Slf � � ���
Facility Number ®- �� 7 ®Division ofpSoil and Water Conservation
Other Agency
Type of Visit: omptiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: r�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /0� - rrival Time: U Departure Time: ,� , County:,s �W Region:
Farm Name: S' _ / f H-p 'qt. �a t ►,~-
Owner Name: �,�r Lts�� r Sp,dl
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: ele dL0'r_.'- Z�- Title: _71--�IG. Phone:
Onsite Representative: � Lorrr/ 1YlO,�r� �� lC -mac // Integrator: /yj& 4
Certified Operator: fznn,k m,4 �5�� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
FC-a
n Cuent,aDesi n Current k Design Carrent
Swore ity Pop �t� Wet,Poultry�Capacity Popp Cattle Capacity Pop.
"` Layer DairyCow
Non -Layer DairyCalf
+� �T � � ��k� " - � �-, .�.,� DairyHeifer
yam. - aDesignCurrent;, D Cow
'ice W�r ��'�� Y[yi�st
D xPo.ul � a aci , Non -Dairy
�{ Beef Stocker
�;: Beef Feeder
Beef Brood Cow
{
Other .ice.; w .
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharees and Stream lmnacts
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
1. Is any discharge observed from any part of the operation?
[]Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
N No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 1Q— p
1
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[KNo
❑ NA
❑ NE
a- If yes. is waste level into the structural freeboard?
[:]Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Idenlifier: '7f lot
Spillway?:
Designed Freeboard (in): f 19
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any ol-the structures observed?
❑ Ycs
M No
[DNA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Co 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 niffer from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
LnkNo
[] NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
17-
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20-
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2: No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes JZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes � No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
[.] NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating .non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 21 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
®, No
❑ NA
❑ NE
❑ Yes
CQ No
❑ NA
❑ NE
,Yes
lidlO
0 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 ext)lain situations (use additional oases as necessary).
7S;d' 7-7rYfbe
�o Q Fo(11x�� t�'5;1"aFtY� 3uo� f .7� �.�•� �o���o
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: —� 3Dd
Date: /Q — /D Z�e
21412011

Date of Visit: rg Arrival Time: Departure Time: County:.-- Region:
01
Farm Name:�y. f/ 171-Dv /tea/.�+� Owner Email:
loe
Owner Name: T _�-/ W opwt K SP'=11 Phone:
Mailing Address:
Physical Address:
Facility Contact: e t�- /9 Z!Am/-"-- Title: �r .
Integrator: cr
Certification Number:
Onsite Representative: Scram �f�
Certified Operator: ,Jl 1r�d 7 tJOt7�l C �. Z/
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current"` a Design Current -,_
Design We
Swine ..
Cava city
Pap s-F:WettPoultry Capacity Pop ;�
C►attle Capacity Pov-
#�:
------------
Wean to Finish
7
Layer
DairyCow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
t
r:
' F
Dairy Heifer
Cow
Farrow to Wean
.- DesignCurrent°
`
D
Non-Dai
Farrow to Feeder
4 D . Poultx Capad0
Farrow to Finish
y Layers 4
Beef Stocker
Gilts
Xisi Non -Layers „
Beef Feeder
Boars
Pullets
Beef Brood Cow
+ " TurkeysTurke
Poults
Other
Other
�..�ax,�u,a::::.-:s�J®M9[do_
_.__m: �lla�-u'-_:: _.� .. z..•:.:::-. .. :ri"IlaJa.:.ad-. '_ -.._ :..
Dischar es and Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
[—]Yes
2 No
❑ NA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
Page 1 of 3 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
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
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
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X 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 77
12. Crop Types):
13. Soil Type(s):
14. Do the receiving crops from those designated in the CAWMP?
❑ Yes
NA 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
[a No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[j�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L& No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LZ_ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
ONon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:14
,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Eg No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
❑ AppIication 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 C, No ❑ NA ❑ NE
❑ Yes §ANo ❑ NA ❑ NE
❑ Yes allo ❑ NA D NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
[—]Yes .,( No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7 P c-oy-�-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:wO'C7
Date:j��'
21412011

Type of Visit 0ollompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: -a Arrival 'Time: Departure Time: County: Region:
IePl
Farm flame: 1__" o-y- 4'e Owner Email:
Owner Name: _ ���w a0� � Phone:
Mailing Address:
Physical Address:
Facility Contact: K S P,- w Title: Phone No:
Onsite Representative: � r�r� ✓���'"�— Integrator:
Certified Operator: 19 rc- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: latitude: =0 0I = Longitude: =0 0. =
Design Current Design
Swine Capacity Population 1\'et Poultry . Gap=ty
Current Design Current
Population Cattle Capacity Population
to Finish
❑La er
❑ Dai Cow
❑ Dai Calfer
❑ Dai Heifer
❑Dry Cow
Non-DaiLaversw
❑Beef Stocker
Feeder
l I
Beef Brood Cow-❑Turke
Number of Structures:
to Feeder
❑ Non -La er
to Finish
w to Wean
w to Feeder
to Finish
FE
❑ Non-LaversPullets❑Beef
s❑
s
❑Turke Poultsr
❑Other
Discharges S Stream Impacts
l . 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 N-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&.No
❑ NA
ONE
❑ Yes
19�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection o- �- /O
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EgNo
❑ 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): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
(� No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
R-yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Dd 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 ayes f" "`" ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)i yyv�t �Iit►j��„l
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
CC No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ 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):
r Lr�t/rfvt� ��17• ram]. �� l�r ��S �
`
47
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: D
Page 2 of 3 12128104 Continued

Facility Number: r�� Date of Inspection E� / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes k No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C�No ❑ NA ❑ NE
25, Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 5d No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LANo
❑ 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
Jallo
❑ 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
Flo
❑ 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
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
j2Uo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

B.ilus 1 Z— 0 '7 - 2 00 4 R %Z .
Dtvuto.n of wt}ter Q6>!.li'
=FftcilitkNumbe'r Sbil and Water Conservation
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
CC,00mpliance
C'7 Routine 0 Complaint
Q Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
I1atc of Visit: iZ 07 0-13 Arrival'Timc: I : OS Departure "Time: //:2 County: tPSa�/ Region: Fleo
Farm Name: :5 Ho� t�atrJt/t Owner Email:
Owner Name: _ D erwoacl k • Ep e, f i Phone:
aNIHiling Address -
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator: Der wcl K. 5p,-?[
Phone No:
Integrator:
Operator Certification Nuntber: Awd-15I// 9
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: ❑o Longitude: =0=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
[ffFeeder to Finish
1/2#0
Z 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairY Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ED
b. Did the discharge reach waters of the State? (1 f 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?
Cl Yes C No ❑ NA ❑ NE
❑ Yes ❑ No I TNA ❑ NE
(I Yes El No IrNA
El NE
❑ Yes ❑ No L'7 NA
❑ NE
❑ Yes E__ t</o [I NA
El NE
El Yes [? o ❑ NA
❑ NE
1212"4 Continued

Facility Number: 62 —#2`7
Date of Inspection IZ-07-Oq
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 Cstructural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: it I ;:P Z.
❑ Yes El"No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): l LM9
Observed Freeboard (in): 31 1 3 f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EB'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��
6. Are there structures on -site which are not properly addressed and/or managed ElLl Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1 oo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C;J<. ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L3No ❑ NA ❑ NE
maintenance/improvement'?
1 i . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2To ❑ 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) Eerw.vcdc,. (tfay L Pa54uvc) S flGra�� t�/rrcvfcr.�
13. Soil type(s) JA a q V-A VL,-t
14. Do the receiving crops diner from those designated in the CAWMP?
❑ Yes
[TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L3No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
ET/NoYes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3� No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E7 No
❑ NA
❑ NE
Comments (refer to question #): -Eaplainlany YES answers and/or'any recommendations or any other comments. ,
Use drawtngs-of facility to better explains situations. (use,additional pages as neeessary):z
Reviewer/Inspector Name r�.( V 1'ZZve_is p Phone: 'PO-Y-33.3300
Reviewer/Inspector Signature: Date: /2 - 07— ZOO y
12128104 Continued

Facility Number: 82 —927
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 [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,_,, �
L.")'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
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
❑ Yes
EN-'
El NA
❑ NE
❑ Yes
I� No
❑ NA
❑ NE
ElYes
9<
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
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? (id discharge, freeboard problems, over application)
32. Did Reviewerfinspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
f No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
0014o ❑ NA
❑ NE
❑ Yes
L7 No ❑ NA
❑ NE
❑ Yes
DN'o NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
1228104

/ er^5 /-06-0?
k'/L
Facility Number
tvisioa of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspections
Q Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral Q Emergency
0 Other ❑ Denied Access
Date of Visit: !Z-d5' U$ Arrival Time: Departure Time: County: .✓ Region:
Farm Name:Owner Email:
Owner Name: _ K . S/s. j Phone:
Mailing Address:
Physical Address:
Facility Contact: iu t m r-e-_ Title: 'lee-L. S O u. Phone No:
Onsite Representative: t`u-r Integrator: )�:rzpan1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 L ="
Longitude: 00 = t = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
/Z 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -La crs
❑ Pullets
❑ Turkeys
❑ Turkcx 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 matt -made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of. Structures: a
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 2No ❑ NA ❑ NE
❑ Yes
❑ No
['DNA
❑ NE
❑ Yes
❑ No
9"PGA
❑ NE
B A
❑ NE
❑ Yes
❑ No
❑ Yes
53'Flo
❑ NA
❑ NE
❑ Yes
['� iTo-
❑ NA
❑ NE
12128104 Continued

Facility Number: f2 -- 4 2 7 Date of Inspection PAt -09-b191
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. _ L� -�/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ETNo, o
ElYes [!No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes Eg o ❑ NA ❑ NE
❑ Yes SNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public healtb or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes B<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[37Go
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
0-Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
B<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,_,,
L7 No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ 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) wag
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
B<o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
B<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[�o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ISNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ <o
❑ 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, Phone:
Reviewer/Inspector Signature: Date: /Z -69- zooa
Page 2 of 3 12128104 Continued

Facility Number: Z — �7 Date of Inspection F'2-'07-491
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 ! g<o ❑ NA ❑ NE
the approprrate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[E o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I"
Rain Inspectionss [:]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,LTNo
L7 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
3,,���io
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,[R
I 9 <o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R o
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
[Bo
❑ 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
9? o
❑ 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
,�,/
L1 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
Q_N�o
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B <o
❑ NA
❑ NE
Page 3 of 3 12128104

r
'Division of Water Quality
Facility Number O Dh ision of Soil and Water Conservation IN I
Q Other Agency q kqA U
Type of Visit -A Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'T Routine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: -b- County: Region:
Farm Name: ��3A 2 L _ `�� Owner Email:
Owner Name:_y �� �.� 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: C` fRULK MWe- Title:
Onsite Representative:0`-v fyw t,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
TJw
Phone No: a
Integrator: rjnp S-�t%
Operator Certification Number: I
Back-up Certification Number:
Latitude: ❑ o ❑ , = Longitude: ❑ o ❑ , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I JEJ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed front any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daity Heifer
❑ Dry Cow,
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E14
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 A ❑ NE
❑Yes El No bir+]A ❑NE
ElYes ElNo xNA ❑ NE
El Yes M No ❑ NA ❑ NE
❑ Yes YNo ❑ 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
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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A 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
Oibgo ❑ NA ❑ NE
through a waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
,Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,_Jsf o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
)QNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�,No El NA El NE
maintenance/improvement?
r
IL Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
CPo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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" those designated in the CAWMP?
❑ Yes
V] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,jallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Ed No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
'0No
❑ 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):
-7.
--�-�so' 1 J
stye ►� jL 5� Sa /,'fie cx r e rv+�i r �,-o S m ►�.. rat I 1 t.��
�Grooc/
70 kcrf rt .SA � ha Cede Sloes
p .2sr,
Reviewer/Inspector Name
1 l t Phone:
Reviewer/Inspector Signature:
Date: T
12128104 Continued

Facility Number: ` — a'j Date of ]Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N�No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9,No
❑ NA
❑ NE
21
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
MA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
QNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;S�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
)dNo
❑ 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] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
" Gtrter 1,1►1I Gj)a, obir rr, e..1r,h r� -�o S�az Wk :cA ser;,jd rs A
,)r-wpe,A r, eacA ayo'
sx
(� r�
Sip � t n [..i �,-4 )4. 0. 1(0 1 a G'C-. � / I I b-3 W e-4L 4C� r s L, y { Q
Y O 6, itAe Srrw" *i ` SF r aw,. n �%✓,}'
Car-r t e-+ I a-z- J,v- Zao �`^_-t1Zoncs,•t D�
C�5 t��S �S a,�� Ln>r s �he_ t.h eatji err44_4;6n
burnt
O, It III acLJ d-C m * Qurs work5-hee1
��rl
SP. mac lea- i rr-+ g P !a n
12128104

C
r
F'acilitNo.
y
Time in
Time Out _ _ _
Date
Farm Name
Integrator
Owner
Site Rep
Operator
No.
Back-up
No.
COC
Circle: General or
NPDES
C
Design
Current
Design
Current
Wean -Feed
Farrow -Feed
FREEBOARD: Design
s14uyG sup vEy� 21 +�, lZ 3- �
Crop Yield
Rain Gauge
Soil Test PLAT
Weekly Freeboard ' Daily Rainfall �T
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
t* z '?
Pull/Field I Soil
P
Observed
CalibrarhnrGPNA r
Waste Transfers
Rain Breaker
Wettable Acres
1-in Inspections
--1)1-0 4 zo
Date Nitrogen (N)
31 J
Pan
Pb{
Vo

r
�� C9
-�C) a
�0
o
G u�
G
QVo
0
o �a
0

Type of Visit 0 Compliance Inspection 0 Operation Review IS Structure Evaluation 0 Technical Assis=Access
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 4 Other ❑ Denie
Date of Visit: 61 Arrival Time: Departure Time: County: Sc'�l7 Region:
Farm Name: �= i1 ► +�� �Y t►'\ Owner Email:
Owner Name: spw Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ O ❑ f ❑ Longitude: ❑ ° ❑ 1 ❑ u
Design Current
Design Current
Design Current
r1so
Capacity Popultion Wet Poultry
Capaciy Population
Cattle Capacity PopWean
to Finish
❑ La er
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
#`
-Feeder to Finish"
❑
sk f,
❑ DairyHeifer
Farrow to Wean
Ury' 'Ro ry
❑ D Cow
❑ Farrow to Feeder"`
° -
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
.. ❑ Pullets
❑ Beef Brood Co
M❑ Turkeys
Other
-. ❑ Turkey Points
❑ Other
Other
Numbierof. Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes IN No ❑ NA ❑ NE
❑ Yes
❑ No 4 NA
❑ NE
❑ Yes
❑ No /d NA
❑ NE
❑ NoANA
❑ NE
❑ Yes
❑ Yes
6No 1] NA
❑ NE
❑ Yes
❑ No ANA
❑ NE
12128104 Continued

Facility Number: a
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: 1 r
Spillway?:
Designed Freeboard (in): R R 4 �'
Observed Freeboard (in): . ;LNl
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 [$jNu ❑ NA ❑ NE
El Yes QNo El NA El NE
Structure Structure 6
❑ Yes 11 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA �NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA 09 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA P NE
El Yes ❑No El NA �NE
❑ Yes ❑ No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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)
❑NA PNE
El NA 1aNE
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA IF2 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18, IS there a lack of properly operating waste application equipment? ❑ Yes
El No ❑NA FNE
❑ No ❑ NA 1p NE
❑ No ❑ NA �INE
❑No ❑NA_�BNE
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):
ac—
cou (� ►t f See �4- f �a,,, 44,
Reviewer/Inspector Name[, ~ Phone:
Reviewer/Inspector Signature: Date: UUV
,Page l of-3 - 12128104 Continued

6
Facility Number: Date of inspection
Required records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 1K NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA MNE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El maps ❑ Other
21 _
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
0 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
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
JU NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
P NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
P NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
;5NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes ❑ No ❑ NA (PNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA PNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA NE
If yes, contact a regional Air Quality representative immediately /
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA +] NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerllnspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA J},NE
Page 3 of 3 12128104

a
Type of Visit Woutine
fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit; 191 Arrival Time: L' [ `�T Departure Time: County:
Farm Name: Owner Entail:
Owner Name: _ _. aa ( I Phone: _
Mailing Address:
Physical Address:
Facility Contack'_-AV ePA- MW V C Title: C- Phone No:
Onsite Representative. Integrator: _ ire-1'!'1 SL
Certified Operator: OK w Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ 0 0 4 ❑ Ii Longitude: ❑ ° = I ❑ u
Design Current
� Design Current
Design
Current
Swine Capacity Population
Wet Poultry. 'Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -Laver
❑ Dairy Calf
Feeder to Finish
❑ Farrow Wean
T`" �ti.,
1
�'�g-
Da i Heifer
❑
to
Dry t?4uttry� `'°r
-
Dry Cow
❑ Farrow to Feeder
'' ° r '';"
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars❑
Beef Brood Co
'yam
Other
'
❑ Other
-
Number of Structures:
❑ La ers
❑ Non -La ers
❑ Pullets
El Turke s
❑ Turkey Points
• ❑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 than -made?
b. Did the discharge reach waters of the Stale? (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
I�No
❑ NA
❑ NE
❑Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
r---�
❑ Yes
❑ No
AI NA
ElNE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/18/04
Continued

Facility Number: — a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. I f yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
'1 L► l !
Designed Freeboard (in): Q[ �{
Observed Freeboard (in): -3
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
throueh a waste management or closure plan?
❑ Yes 6No ❑ NA ❑ NE
❑ Yes ❑ No 1P NA ❑ NE
Structure 5 Structure 6
❑ Yes
�o
[I NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Rlo ❑ NA ❑ NE
(7 V
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes to
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 10
maintenance or improvement? Z `'
Waste AnDlicadon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
maintenance/improvement?�No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ls�o
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of .Area
12. Crop type(s)
a . 'AV_N%X►�
❑NA ❑NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
1
14. Do the receiving crops differ from those designated in the CAWMP?
El yes No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ?
❑ Yes o
❑ NA
❑ NE
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 PNo
❑ 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):
fi � 4s�
'p �`` ;.
lV ci t �t ua C.0 iQ- A
LM&in t�P.�er w4k F`lc
LotkAa awca V&d .N :CAS C -"&tL ,i; ma
Nlit : t�.Y �- 6cL", ����.
Reviewer/Inspector Name CAA �4ST i Nf— 0_10AJ Phone:Q 1 o
Cp
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facili1W Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes , o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
❑ Yes Wo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
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
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
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
CN14o
❑ Yes o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ,ebjIo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ro ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ 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
ElNA
❑NE
If yes, contact a regional Air Quality representative immediately
PNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings::-��
1
Page 3 of 3 12128104

Z H 94 2
Type of Visit # Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit S Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2S CCQ Arrival Time: Departure Time: County: Region: ER-40_
Farm Name: __ter_ Owner Email:
Owner Name: _ _ D Phone:
?14 trr+�" pp� f ` _ �$
Mailing Address: � 1Fdl _ . w� N L �- �Z
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: D V,
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
0
i Z2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: P5f q
Operator Certification Number: « l
Back-up Certification Number:
Latitude: =10 01 =" Longitude: =0=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
Dry Poultry
❑
Lavers
❑
Non -La ers
❑
Pullets
❑
Turkeys
❑
urkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ 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 Isom 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
P5 No
❑ NA
❑ NE
72128104 Continued

Facility Number: 87- -- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ 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: 0>1_ 1
Spillway?: !Qa
Designed Freeboard (in): 12Ai 20 •- _
Observed Freeboard (in): - '7 . - 277-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes *No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
E5 No
❑ NA ❑ NE
maintenance/improvement?
IL _ Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) DS O.,
. j�4.
13. Soil type(s) A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:❑ Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Comments (refer'to quesiion #) "Explain any YE5' answers and/or any_ ecommendations or any,other commenw
Use drawings of facility to better explain situations. (use additional pages as necessary):
kip "Yoeil b��� �.� �C-� '16._1_L %.4ore_
Reviewer/Inspector Name _j.1 A Phone: 41p- `i8(orI, Y!
Reviewer/Inspector Signature: Date: 2S O�
12128104 Continued

facility Number: 82, — 4fZ} 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 LKNo ❑ NA ❑ NE
the approprrate box. t [D Desi ❑ WUIr ❑ Checklis g**,"n Maps&150ther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA
❑ NE
❑ Waste Application❑ Weekly Freeboare❑ Waste Analysis Soil Analysiil'j� Waste
Transfers
❑ Annual Certification
❑ Rainfalk'❑ Stockink""❑ Crop YielV ❑ 124 Minute ]nspectiont✓❑ Monthly and I" Rain Inspection*-
❑
Weather Cods/
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
ti
❑ NE
23.
lfselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
(I Yes
❑ No
KNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the tacility fail to conduct a sludge survey as required by the permit`?
❑ Yes
2.No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
CKNo
❑ NA
❑ NE
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 sail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge. freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
Additional Comments and/or Drawings:
a: Vt ate ,
I V�tSf
o I to par- a-cr 4
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
❑ Yes 29 No ❑ NA ❑ NE
❑ Ycs �No El NA El NE
❑ Yes [NLNo ❑ NA ❑ NE
K f (PlaY 2 .'j
Z� 1 Y/ey z_Z
et
Set-;
5
ba'
A--rrf.z
`f)(GO) 2
4-+, Sao
P s�
8,9 0-r- -fie r-+

jType of Visit (VCompliance Inspection O Operation Review Q Lagoon Evaluation I
Ij Reason for Visit O'Aoutine Q Complaint O Follow up p Emergency Notification O Other ❑ Denied Access
Facility Netmber Dale of Visit: S �% o Time:
Q Not Operational Q Bellow Threshold
[Wermitted U16rdfied E3 fConditionally Certified © Registered Date Last Operated or Above Threshold: ..... .-.- �._.....
Farm Name: .----...��1_. - L_f � I '��•"' County:�^
Owner Name: K.� f ........... .... Phone No: _........L.-..a5 ....._�- W.
Mailing Address: r
Facilitv Contact: 2 1 ✓✓.. Tide: ..... ........ ......... .... Phone No: _. ____............ ......
Onsite Representative: _D• yl . S f I< 1_--_-_-•------•-•---._.._-_._.-•--_-.... Integrator: _---__-_--
Certified Operator:, ••-� t��rir�oa•.-• -..- ..-. ,'l.� Operator Certification Number:
Location of Farm:
MIS,wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �° ���
Desigh ;' Current Deo Current _.r Y_ Des Current
Swine Po elation Poultry Ca . Pa dlatiaa Cattie
-z a 'Po ulatii -
F.
Wean to Feeder ❑Layer ❑ Dairy
eeder to Finish p ❑Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder❑Other: -
Farrow to Finish Total Deli Ca act "
Gilts P �'
Boars Totat SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2fgo
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 gaUmin?
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 GI Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ENo
Waste Collection & Treatment �,�
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway El Yes !moo
Structure 1 Struct� 2 Structure 3 Structure 4 Structure 5 Structure 6 ry
Identifier:... `. ......................... ..-....
........... ._.
Freeboard (inches): S 9-9
12112103 Continut -f

)Facility Number: Date of Inspection 7 b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
Iff<o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
[]Yes
©No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
No
7. Do any of the structures need maintenance/improvement?
❑ Yes
E
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
U4c4o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
G144-07
elevation markings?
Application
_Waste
10. Are there any buffers that need maintenancetimprovement?
❑ Yes
D1<0
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ER140
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Wasw Management Plan (CAWMP)?
❑ Yes
E!'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Bf-1a
b) Does the facility need a wettable acre determination?
❑ Yes
2 No
c) This facility is pended for a wettable acre determination?
❑ Yes
EJ lvo
15. Does the receiving crop need improvement?
❑ Yes
(TNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
2<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes MNa
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [fNo
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M-No
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.
Comments (refierr to quesfiiQn #) Eiiglatn any YES answers and/or any recom�enda#tons or.any adier.:eommrnts. r
°Use drawings of iacility to better explain stuaboas. (ase addt4onai gages as necessary;}eld COPY ❑Final Notes r
_
" o�d r2..Lora�
-� � k l Gi. ►v�i l� `t tb�.y MD�w!
J70vt L r
Reviewerlluspector Name
Reviewer/Inspector Signature:
J- =lL,
12112103 ' -- Continued

Facility Number: ' — JjL
Date of .inspection s D
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes Rgo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1.IP, checklists, design, maps, etc.) ❑ Yes j1io
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O N" o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNO
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Ei No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
[]"No
(ie/ discharge, freeboard problems, over application)
❑
27_
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[3No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
2 No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ i1 o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[jgo
3I _
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1"Rain
/ ❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You wW receive no further correspondence about this visit.
12112103