820494_INSPECTIONS_20171231

NUHTH CAHOLINA
Department of Environmental Qual

Type of Visit: J'Compliance Inspection U Operation Review C) Structure Evaluation U Technical Assistance
Reggon for Visit: O/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date o Visit: Arrival Time: f O Departure Time: County: lg
Farm Name: Yc�c-� Owner Email:
Owner Name: Co kgr (a-y -e— Phone:
Mailing Address:
Region•
Physical Address:
Facility Contact: Cwl•J�k 5°' �'�'�2� Title: Phone:
Onsite Representative: Integrator:
Certified Operator: l( Certification Number: �{
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity
apacity
Eop.
Cattle Capacity Pop,
Wean to Finish
Layer
Non -La er
I
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
—,o
" '
Dairy Heifer
Farrow to Wean
D , Ioul
Design
Ca aci
Current
Po
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
0`ther
Turkey Poults
Other
Other
Discharnes and Stream Impacts
I. Is any discharge observed from any pan of the operation?
[] Yes
[L o NA
❑ NF.
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E]_DIA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
LJ�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
[fr—NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -Liq jDate of ins ectionr ►
`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):
D-5o ~❑ NA ❑ NE
❑ No g3-<A ❑ NE
Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3'N-o ❑ 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 E�JIo ❑ NA ❑ NE
waste management or Closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0--No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q "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 [a-l<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g3 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):
W 3
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JDIo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Lg2 �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RE l"o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes l" <o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Flo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6<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 ❑ l20 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Ef)No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
0 NE
Page 2 of 3 21412015 Continued

Facili ,Numbkr; - Date of Inspection: / "t`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ-P-o ❑ 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.
n Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
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 o ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0- o 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 2 Vl'o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility9 If yes, check the appropriate box below.
❑ Yes
[3'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNP?
❑ Yes
C3 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[/rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
('No
❑ NA
❑ NE
t n I
Reviewer/Inspector Signature: � Date: L t
Page 3 of 3 21412015

C _
ResourCeS' r Tit T „ F
Facility imber - Q Division af•Scil-and Water'Cansenatton
Other Agency.'
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: sQ� County:
t- 'ti � �+"� rl
Farm Name: 4, GOwner Email:
Owner Name: cGk A,ir t-t r -f Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: (74_,4Title: Phone:
Onsite Representative: { Integrator: -7lbti �L_,o
Certified Operator: Certification Number: % r 3Yz
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish I I I I Layer
Wean to Feeder 1 .1 co I .—V— ]IL Non -La er
Feeder to Finish
Drys'I'oult
Layers
Non -Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Turkeys
Other
Other
Turkey Poults
Other
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 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?
Cattle
❑ Yes [ `'o ❑ NA ❑ NF
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑' No
❑ Yes
E:fNo
� A ❑ N I
ff'NA ❑ NI
dNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Fagili Number: I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C31Z ❑ 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): 3rZ)
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V�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
lo
❑ 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
MNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
Ef 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, .fin, 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): C�
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
[i]'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
[] Yes
b 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
[ fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[TNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ 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 [�fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q 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 0 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 EfINo ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2-No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
[] Yes ONo ❑ NA ❑ NE
❑ Yes [a"No ❑ NA ❑ NE
❑ Yes
[fNo
❑ Yes
EfNo
❑ Yes
dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawings of facile to better explain srtuatiops (use additional pages`as necessary). ;.� her+comments: Comments (refer to question #) Explain any YES. answers and/or any additional recommendations or -any of
spa" 1
g
CAb 1-0
V9
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: q 3 1 -3 m3
Date: r l
21412015

6Pt
IL
Type of Visit: UCoZoufine
fiance inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (s)'0 Complaint C7 Follow-up O Referral Q Emergency Q Other 0 Denied Access
Date or Visit: (71 n 1 Arrival Time: Departure Time: ]b 0 County: 'S 4)4t
Farm Name: r.�.e41,r / V f ti! Ao er-Lf Owner Email:
Owner Name: C �1sur c�g� `5 Phone:
Mailing Address:
Physical Address:
Facility Contact: ` ao_�i S Bad- Title:
Onsite Representative: 1 `
Certified Operator:
Back-up Operator:
l�
Phone:
Region:46F�
Integrator: f�✓�eS rn.2
Certification Number: r�
Certification Number:
Location of Farm: Latitude: Longitude:
Design Cnrreat
Design
Current
Design Current
Swine Capacity Pop.
Wet Fouttry
Capacity
Fop.
Cattle Capacity° Pop.
Wean to Finish
airy Cow
Wean to Feeder dr
Non -La er
a'y Calf
Feeder to Finish
_.— : ,..•_
, .._. ,.
Dai Heifer
Farrow to Wean
Design
Current
DDLCow
Farrow to Feeder
av
aci
Po
Non -Da'
Farrow to Finish
rs
La ers
Layers
Beef Stocker
Gilts
[Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qtber
Turkey Pouets
Other
Other
Discharees and Stream Impacts
l . Is any discharge observed from any part of the operation? Yes Q4ftr- ❑ NA [] NE
Discharge originated at: ❑ Structure Application Field ❑ Other:
a. Was the conveyance man-made? Yes [] No E j A [] NF
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes [] No [2-NA NE
c. What is the estimated volume that reached waters of the State tgallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) Yes No [�f 'NA NE
2. Is there evidence of a past discharge from any part of the operation? Yes Q No NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes Ld"'No Ej NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility dumber: - Date of Inspection:
Wdste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3.Akr ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []-#r'-❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ifb
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [P-Ko" C] NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C31No
[] 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 markets 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
[201�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA 0 NE
❑ Excessive Ponding 0 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
EE IKo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
Q--K_o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]'Po
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need 'improvement? If yes, check the appropriate box below. ❑ Yes [a'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 d�qo
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F(No
❑ NA ❑ NE
❑ Weather Code
[]Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Con inued

Facility Dumber: jDate of Inspection- 10
24_ Uid the Facility fail to calibrate waste application equipment as required by the permit? 0 Yes [ZrNo ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [;J44o ❑ 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 [A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q No ❑ NA ❑ NE
❑ Yes n-'�o ❑ NA ❑ NE
[—]Yes [�KNo ❑ NA ❑ NE
[—]Yes [:JNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes [fNo ❑ NA ❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #) �Egplam any YES answers and/or any additiona1recommendations or any ;otlher comments.
Use drawings of-tacility to better B lain sataa#tans_(use.additiapal pages:a necessary).
Edo k
� � J
Reviewer/Inspector Name: i Phone: � 3-3'3�
Reviewer/Inspector Signature: Date: (J ! l v
Page 3 of 3 2/4 14

0-9 / It
Type of Visit: QyIIEbmpliance Inspection U Operation Review U Structure Evaluation () Technical Assistance
Reason for Visit: (34outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r County: .� Regioi
Farm Name: L_,C 4 caner Email:
If
Owner Name: ,A..a, Phone:
Mailing Address:
Physical Address:
Facility Contact: �yEc�. �'1~$d� �`(�i i��i itle: Phone:
Ousite Representative: t ( Integrator: irl"tC
Certified Operator: Certification Number: ' f 3 '{
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Cnrrent
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
*. Design Current
Cattle " Capacity Pop.
a„
Wean to Finish I
I Layer
Dairy Cow
Wean to Feeder b-0 I
lNon-Layer
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
--Design
Current
Dry Cow
Farrow to Feeder
D . P,ouI
Ca aci
P,o
Non -Dairy
j Farrow to Finish
Layers
Beef Stacker
Gilts
Non -Layers
Beef Feeder
Qfl
Boars
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ED-i`o ❑ NA ❑ NE
❑ Yes
❑ No
[]-KA
❑ NE
❑ Yes
❑ No
[3-NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) []Yes [:]No NoE],NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E3<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Fncili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EalVo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[i]'FIo
❑ NA
❑ NE
(i.e., large trees, severe erasion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
21 o
❑ 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 en�lronmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2 110
0 NA
❑ NE
8. Do any of the structures lack adequate markets as required by the permit?
❑ Yes
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
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 E No ❑ NA ❑ NE
❑ Excessive Panding ❑ 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): 3 OL
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
g4o_
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P Iqo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�' Il�o
❑ NA
❑ NE
18. Is there a tack 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
�o
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EI 1'0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21417014 Continued

[Facility Number: -0 jDate of Inspection: )V-
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes &W
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2-Ko
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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
❑ Yes
[]l o
❑ NA
❑ NE
❑ Yes
[g-Ko_
❑ NA
❑ NE
❑ Yes
C2,114o
C] NA
❑ NE
[:]Yes [?lq-o ❑ NA ❑ NE
[—]Yes GrIZ ❑ NA ❑ NE
[]Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes Z No
❑ Yes / No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional, recommendations orany other comments.
Use' drawings of facility to better; egpiain situations (use additional pages as neeensa ry).
c4t 6 r-4 r t>-%sr-
13
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: JJ�3
Oate:
21412011

L
Type of Visit: (DCornpliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: 04outine 0 Complaint 0 Follow-up Q Referral O Emergeney O Other O Denied Access
Date of Visit: rrival Time: Departure Time: County: � Region:Q
Farm Name, owner lhail:
Owner Name: ccN/-c W JK.1 Phone:
Mailing Address:
Physical Address: ' Faclity Contact: Phone:
Onsite Representative: f( Integrator:
f 0J '(/
Certified Operator: � Certification plumber•.
Back-up Operator: Certification Number:
Location of Form: Latitude: Longitude:
Design Eurrent f Design Current Design Carrent
�z ._
Swine Capacity Pop. Wet Poultry_`Capacity Pop. Cattle :' Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder —0— Non -La er Dairy Calf
Feeder to Finish
- Dairy Heifer
Farrow to Wean
Desi nCurrent Dry Cow
Farrow to Feeder
D , ,P,oul-y.Caag Pto Non -Da'Lry
Farrow to Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Pullets
Turkeys
Other
Turkey Poults»'
Other
Other'
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Uj>,K ❑ NE
❑ Yes
❑ No
[2jNA
❑ NE
❑ Yes
❑ No
[q-TQ
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No Q.N7C ❑ NE
[:]Yes Cgl<o ❑ NA ❑ NE
❑ Yes [J. o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

�Facili Number: Date of Inspection::
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 417
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ 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 [j 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 ff'N"40 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 12<0 ❑ 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [jLb1&- ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [j�o ❑ 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): ��� in
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CZ[Ao ❑ 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 �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0-bIo ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑- Yes E3'9o_ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [J.If ' ❑ NA [] NE
the appropriate box.
❑WUP ❑Checklists [3 Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [Z .No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C]"N o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

A
Facili Number: - Date of Ins ectionc` ' [
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0-1 -o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ 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 Epq* ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes g),No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 14 10 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
[]Yes [6.3do ❑ NA ❑ NE
❑ Yes �o ❑ NA [] NE
❑ Yes (a —No ❑ NA ❑ NE
❑ Yes [LJ-N-
❑ Yes G�1<0
❑ Yes [a'1(Io
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

i ype of visit: a=F;uompnance imspecnon tV uperanon xevtew U Ntructure Evaluation U x ecnntcal Assistance I
Reason for Visit: OlrCuutine 0 Complaint 0 Foltow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t C7o Departure Time: (7 County:�d..�
Farm Name: �, .,� y� 5il/07.4 116 X1A2 &,L57"wner Email:
Owner Name: [�/�/�ar ffp h &V"-" / Phone:
Mailing Address:
Physical Address:
Facility Contact:Title:
Phone:
Region: Fj O
Onsite Representative: �fa��.� Integrator: ' `7
Certified Operator: _S� Certification Number: /Fr3y�
Back-up Operator:
Location of Farm:
Latitude:
Certification Humber:
Longitude:
Design Current
Design Current
Design Cnrrent
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
oc,
Non -I a er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
01 . P,5UIt . Ca aci. P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
OtherI 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [&No ❑ NA ❑ NE
3. Were there any.observable adverse impacts or potential adverse impacts to the waters ❑ Yes P No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
j
Waste Collection & Treatment
04. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg 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): 5-D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C& No
0 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
gj 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
[y4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
{KNo
❑ 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): rw J W&4,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CK No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ANo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ®No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ONE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
—/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
lX No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
� No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
R No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
� No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
(4 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
EQ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[& No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J&No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or -any. other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �G �` ez— Phone: �/V-y33`3Jt
Reviewer/Inspector Signature: Date:j_'3
Page 3 of 3 21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y a. Arrival Time: v Departure Time: t+cy County:
Farm Name: Lg1F4,4 4 t p FAiirn S ` S ,�t,,�,5f_{L`� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical.Address:
Region: PR 0
Facility Contact: ,,� ,P W�� Title: Phone:
Onsite Representative: �S t�Q�. are .IL Integrator: -A Z-'S-�ps s.
Certifiied Operator: Certification Number: 1$ 3 1-0
Back-up Operator: r% Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
I)6ign Current
Design Current
Swine Capacity Pop.
Wet Poultry `Capacity . -Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
e
Des "n Curren#
Dry Cow
Farrow to Feeder
Dray Poult_acity Plo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La era
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [!�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No C�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑'NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
1.
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
[:]Yes U No
❑ Yes [2 No
g NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: 8k, - t.1 q LA Date of Inspection:
Waste Collection & Treatment
4. Is heavy less
No
storage capacity (structural plus storm storage plus rainfall) than adequate?
❑ Yes
E
❑ 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): �c{
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]I ' 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
[S(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
[]INo
❑ 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
Q 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
[gNo
❑ 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): pR. q\ ( is
13. Soil Type(s): ]�
Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[g No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Camo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EOIN o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes
❑"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
[3,1Go
❑ 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
C3"'-No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes []?/N o ❑ NA ❑ NE
Page 2 of 3 21417011 Continued

Facility dumber: f3 a - LITq jDate of Inspection: 4 1�
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [f(No
25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check ❑ Yes [2'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 provide documentation of an actively certified operator in charge? ❑ Yes Q'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ INo
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
[!f No
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
allo
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
[�j No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain an' YES answers and/or any additional recommendations or any other coinntents
Use drawings of fadilty to better explain situations (use additional pages as necessar3) `t
_z.
Reviewerllnspector Name
Reviewer/inspector Signature:
Page 3 of 3
Phone: C>016— Ld$Si _
Date: t a-
2/4/2011

' _ - ,���son�of�Water Quality
Facility Number ®-' Q Division of Soil and �'t!ater Conservatiou
Q�,Other�A_gency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ir/ o7/JJ Arrival Time: 1 b0 Departure Timer County: Region:
�"�j j�I
Farm Name: ner Email: �Q.#-P� �-S LLB _'
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ( IAS *,�_L,,S_ Title:
Onsite Representative: 1�
Certified Operator: 0A,"-hS 4"zk, --
Back-up Operator:
Phone:
Integrator:+��c�
Certification Number: (3 34A -
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
DesignCurrt nt
Design C•urreat
Swine Capacity _ Pop.
Wet Poutttry Capacity Pop,
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder i'jt7
Nan-1 a er
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
W__.
NDesign'Cu merit
Dry Cow
Farrow to Feeder
On
ltry Caf aci K P,o
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
NJ
Beef Brood Cow
Turkeys
Other _
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Io ❑ NA ❑ NE
[]Yes
❑ No
E NA
❑ NE
❑ Yes
❑ No
[D<A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No D"KA ❑ NE
❑ Yes [;�No
� No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: ' -
Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
Ga o
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3<0
❑ 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
[ o
❑ 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
2'<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
La"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
[3 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 rWindow �❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CSC o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E[I o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2-<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes NA ❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application? ❑ Yes E],Ko ❑ NA [] NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E •f o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
l0 o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fj_,io
❑ 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
[Dx°
❑ 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
PIqo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0-5-' ❑ NE
Page 2 of 3
21412011 Continued

[Facility umber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . [:]Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'Po ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [:]No Q-1qA ❑ NE
Other Issues
29. 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 �o ❑ 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 FL-4, o ❑ 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 �lo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes WNo�
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Use drawingreferto Ex lainau YES answers and/or an additional recommendati
s of.facil to better explifn,sitostions= use;additional pages as necessa Comments _ ons;or an other coEnme n 4
Reviewer/Inspector Name: 0&t4 CAA- Phone: O —
Reviewer/Inspector Signa e: Date:
Page 3 of 3 4/2011

Type of Visit Com nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: I "21ZD%Q Arrival Time: : 30i4 Departure Time: 3�Punty: E' A�/_ Region:
W/
Farm Name: Ala�`'t'�9 T Owner Email:
Owner Name: 004, an --I Z- Phone:
Mailing Address:
Physical Address:
Facility Contact: �u+�S�sr►�J,'ZfL Title: ��'�-�'�P�[—. Phone No:
Onsite Representative: Integrator: (S6 Z+dYtk t
Certified Operator:
Back-up Operator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: 1=1 o= I 0 µ Longitude: = O a d 0 i/
p Design � .Current
Swine Capacit} Popnk latio�n
❑ Wean to Finish
21-wean to Feeder - O 70
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
We# Poultry C•aitacihi'o1►ulation
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 1'oults
❑ Other
Design Current
Cattle Capacity liapolation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
[T NA
Cl NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
CTNA
❑ NF
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)
ElYes
❑ No
CrNA
El N E
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No❑
NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: g2 — 9 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
Identi fier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 13
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 3<o
❑ 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
RN ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
BNo ❑ 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 Cl Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes
ONo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes Yes
,�
o ❑ 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 El Application Outside of Area
12. Crop types) 6P f—AJ — 1W LC'.' � — R4 it/ S
13. Soil type(s) : o (& of -S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes- ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer.to question #): Explain any YES�answers and/or any recomtneadattiins or�any other4comme -
Use drawiizgs`of facilih, to better explain situationi (use additional pages as necessarv)' " 1
Reviewer/Inspector Name F j tKy' Phone: 9t0 5t 3.33 00
p0,,
Reviewer/Inspector Signature: /Q /ti.G•-.wc -- Date: / —2/— 2 0%0
12128104 Continued

Facility Number: 132 — 9 Date of Inspection I-2�'ZolO
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 3 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections O Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EEI NN.
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Lf oo
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
3 No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
,
L2No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<
[INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
G o
❑ 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
[R<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
El Yes
E31" .
❑ 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
B o
ClNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Rlq'o
❑ NA
❑ NE
12✓28104

T,Ocs /,0 - 0 8 -ZOO
Facility Number �Z
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
& t<outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
DateofVisit: V-ID—�6f`j, IArrival'I'ime: %�.�G� Departure Time: County: s�'L Region:
Farm Name: /Yl���'jj�/ ��t �St'i-�1 Owner Email:
Owner Name: �y`�'V r'�— Phone:
Mailing Address:
Physical Address: /
Facility Contact: ��► ✓`}�G 6'4J�LL'L - __Title:Qu Phone No:
Onsite Representative: Integrator: 14cii. e
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 1 = {! Longitude: = o = d
Design =; Current . Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑Wan to Finish
can to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
(--]Boars.
Other
❑ Other
❑ Layer
❑ Non -Layer F T::�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ urkey Pouets
❑ 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 Curren
Cattle Capacity Populatit
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Braod Cowl
V-
Number of Structures: ©,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No WNA
<❑ NE
❑ Yes ❑ No ❑ NE
❑ Yes ❑ No L_j NA ❑ NE
❑ Yes �`NEI
❑ NA El NE
El Yes NA ❑ NE
12128104 Continued

- A 9'Z — Y946 1-/0 • '19
Facility Number: $Z — Date of Inspection 0
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Etgo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9<0�
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B"50-
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
El Yes
�-
E3
❑ 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
Ej No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2<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
�,�
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ejx6 ❑ 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 ElApplication Outside of Area
12. Crop type(s) Cc> L,—^/ — r•U / ­0r
13, Soil type(s) ,_.,��
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes E o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LfiNp ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ETNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ErN' oo ❑ NA ❑ NE
18, is there a lack of properly operating waste application equipment? ❑ Yes BNo ❑ NA ❑ NE
K s 7L 7Z.:::,c
f'
�✓ � ZvrJ � y��-� �
Reviewer/Inspector Name r C> Phone: -CV17. V53 13331
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

F2. - YiW
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IT No ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design ❑Maps El Other �, �
21. Does record keeping need improvement? if yes, check the appropriate box below. El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ fo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElL7 Yes
,El<o
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑i<
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2<
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L1110
❑ 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
3 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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
E No❑
NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
0 No/ ❑ NA
❑ NE
Comments and/or
12128104

Type of Visit (3-6o`mplianee Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit &outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: - Arrival Time: v: Departure Time: rp`QQ County: Region:
Farm Name: _ C©Ila %- k c- ws s Net Uf�c+'7 _-- Owner Email:
Owner Name: lei by- 14i C _ �t /�Grs..t Phone:
Mailing Address:
Physical Address:
Facility Contact: ,S ti1'G�1'L I'� Title: cc _ Phone No:
Onsite Representative: Integrator: C6 (spa E t.-_ _25agnKS
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = L = Al Longitude: = o = 1 = u
Design
Current = Design Cren urt
Design Current
Swine Ca aci
p ty
_. _
Po ulation Wet Poult -
p t y .Capacity- Population
• attic Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder Oa
ILI Non -Layer
1
❑ Dairy Calf
Feeder to Finish
�!'
El Dairy Heifer
❑ Farrow to Wean'
❑ Dry Cow
ElFarrow to Feeder
-'
ElNon-Dai
❑ Farrow to Finish
❑ La ers
El Beef Stocker
lGilts
❑Non-Laers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Turkeys
El Beef Brood Cow
-
Other
❑ Turke Poults
❑ Other
❑ Other
Number afgStructures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes ❑ No D<A
❑ NE
❑ Yes ❑ No CJ NA
❑ Yes ETNo ❑ NA
❑ NE
❑ NE
❑ Yes L'J No ❑ NA
❑ NE
12128104 Continued

Facility Number: TZ — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 0 No
❑ Yes No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 7
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 lr 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) threes notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ��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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes hd No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or IO 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) neA/ , LAjice, k�ryt,il.,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[6 ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes7r4d
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
El NA
El NE
IT Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
rVN-o
❑ NA
❑ NE
�. �..,.. - -�., ';ate. -
A ammentsj(refer to queshvn #) Ezplarn an ;ESA answers andlor�any! recommendatio_nsjor anyjother eomments.,,1
'Use°dra of facth. ' to better ei lain situations. use:addttiotial, es as�necessa
AL
Reviewer/Inspector Name W1 c. ¢ �/ l $ Phones /4/ S�33.333Ci
Reviewer/]nspector Signature: Date:
Page 2 of 3 I2/28/04 Continued

Facility Number: 72- —1�LQt� Date of Inspection �/ O
Re uired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNNj
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes ElNA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If es, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
P g P Y
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z
ONA ❑ NE
2S_ Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ N£
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes d
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o El NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes 7 ❑ NA ElNE
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? ElYesZEINA [I NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ NA El NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional C6minents andliir
Ak
I d
Page 3 of 3 12128104

.y l3IMS c, .r.4 9—/8-2407 KR-
® Division of Water Quality
Facility Number ��Z © Division of Soil and Water Conservation
0 Other Agency
Type of Visit 4& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: —/ ~D Arrival Time: Departure Time: : Zd County: EM
Farm Name: Al ii Alai✓ Owner Email:
t.
Owner Name: _., 00 40,y1 e_ Fr."ywt Phone:
Mailing Address.,
Physical Address:
Region: F
Facility Contact: ay -S �� ryi c,� Title: I Phone No:
Onsite Representative: Integrator: { _&&' e_);�J OLS
Certified Operator:
Back-up Operator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: = o = ` 0 `4 Longitude: = o [= 4 [� .1
Design Current Design Current Design Current.
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Papuiatioa
10 Wean to Finish I
Wean to Feeder-7op AD
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
Other
❑ Other
❑ La er
❑ Non -la et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharkes 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse itnpacts to the Waters of the State
other than from a discharge?
❑ Yes F No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑NA
ONE
❑Yes
ONo
❑ Yes
2 No
❑ NA
❑ NE
Ca Yes
® No
❑ NA
❑ NE
12/2"4 Continued

Facility Number: OZ. — ryV 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): 1 , If
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rM No
❑ NA
ElNE
(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
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) `
14.
Do the receiving crops differ from those designated in the CAWW? ❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[A No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
M No
LP
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
0 No
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
C9 No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. s
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name " G ize LS 1 Phone: ft . 5E33 .336O
Reviewer/Inspector Signature: R 41� Date: rl—13-Zad 7
I2128104 Continued

Facility Number: Date of Inspection 9 — Cl 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes UrNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA [IN F.
❑ 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
[M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JH No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(,� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E`No
❑ NA
❑ NE
Comments and/or Dravrings:
12128104

Type of Visit t*toinpliance inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (5 Routine Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: : c3 fl County: Region: 19
Farm Name: if®ho«• r il)Gui �ur,57-ry Owner Email:
Owner Name: _Cl9 ate; e- dlrt. Phone:
Mailing Address:
Physical Address:
Facility Contact: CG[I`_jt. 50rW i C A Title: �P/hone No:
Onsite Representative: 5-A4 -s- Integrator: l'" //,' /: e,
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e El' Elm Longitude: = ° = d =
Design Current
Resign Curent
Design
Current
Swine Capacity Population
Wet Poultry Capacity P:op lation
.�
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Non -Layer
❑ Dairy Cow
canto Feeder I`%
❑ Dairy Calf
❑ Feeder to Finish F
❑Dai Heifer
❑ Farrow to Wean-}
Poulk -
Dry try#_ �� ;}� �--.__..
❑ D Cow
Q Farrow to Feeder
�
El Non -Da'
El Farrow to Finish
❑ ers
El Beef Stocker
❑ Gilts
Non -Layers
❑ -La ers
❑ Beef Feeder
❑ Boars
Pullet.
❑ Pullets
❑Beef Brood Co
-
❑ Turkeys
Other
❑ Other
ElTurka Points.
❑ Other
Number of Stnicfures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PS 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 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
[9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1
Facility Number: $�� — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I sr ff a C_
Spillway?: l`lr
Designed Freeboard (in): 1 9
Observed Freeboard (in): / g 13
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 C. No ❑ NA ❑ NF
❑ Yes �0 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes I&No ❑ NA ❑ NE
[]Yes �SNo ❑ 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 JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA N NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 18 No ❑ NA ®NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (' DvP el
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
29 No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):/
f�j j .% C 1 ► bn-was bcea-v� PI�C� —�t: rr"�. a/✓L 6D! 4OB1�r'�4 e
•►
I��
�eVb01.3 C 0cl I J A/0' Fi �^ 6t �Yia�r„ ele 4 11�--
Reviewer/inspector Name �i �' „� Phone: 3 33 DD
Reviewer/Inspector Signature: Date: Oro
Page 2 uj3 12128104 Continued

Facility Number: — Date of Inspection ®!o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ;4 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
BNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
29NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
(NNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[M NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
IR 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
VSNo
❑ 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
VSNo
❑ 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
9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings
•
T
Page 3 of 3 12128104

® Division of Water Quality 4/
Facility Number, i J _ O Division of Soil -and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: --%-2S'O Arrival Time: Departure Time: County: _ 7,t j4an/ Region: /4:!/Zo
Farm Name: Co 6,c v-i e- hFv. Me, r AIL& --se ,ram_ Owner Email:
Owner Name: lt- i G.- Fay k%,�L d� Phone:
Mailing Address:
Physical Address: /T?
Facility Contact: _(2V_V�S— 1k_iisli,"' —Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [1U [1, [ Longitude: [Ao
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
[Z Wean to Feeder QD 1 11-15'7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkev Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I
I-
D Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CANo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[1)No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
�O No
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
12128104 Continued

1
,
Facility Number: 8z — Date of Inspection �S—O
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
[3 No
❑ NA ❑ NE
-Structure Structure© Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?_
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rA No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
P No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit!
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind El Application Outside of
Area
!Drift
12. Crop type(s) 11j+ t.I%f 41VAI uC., f S
13. Soi l type(s) .� o � n ► S
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[It No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
qNo
❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
[�No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA ❑ NE
Comm s er, to question #]• Explamian YtESrainswers and/or arty recommeons or any other comnaCnts.
Use dravr�ngsrof fac* to Better ei: Iaut si&ittffih (use additional pages as necrakc essary):
Reviewer/Inspector Name I - IK ice, [ _ r „f Phone: (WO) 1176
Reviewer/Inspector Signature: Date: 4e — 2 S—ZOd !P
12128104 Continued

f
w
Facility number: $Z :474/ Date of Inspection - zS-4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C% No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fj No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Of No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annuat Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CR No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
[;?No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[;?No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by saute agency?
❑ Yes
['No
❑ NA
❑ NE
Addihopal Commejri sY, tttdltir Drawiiigs {
12178104

_e
__._� _ S Division of Water Quality
R-iliq Numbetr �a ySY_ 0 Division ofSoil and Water Gonsenation
0 Other Agency
Type of Visit *Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: : DO 1 Departure Time: County: S10—j2sw-; Region:
Farm Name: IM Co Xa.- ! c %hod �.arM" s JIUi, /V'� se..Owner Email:
l
Owner Name: Cd AAh— t Hau _ Phone:
Mailing Address: O P LJc s f Qy�2
Physical Address: _ C .%c•�
Facility Contact:
Title:
Phone No:
Onsite Representative: Cc.. >r r /Oey ; e i_ _ Integrator:
es
Certified Operator:— 4:,,/ x, _��rr�., )�� _ Operator Certification Number: . 1 f3 V
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: a o = i ❑ ,. Longitude: ❑ ° ❑ I =1 u
Swine
- Design Current Design Current
Capacity Population Wet Poultry .Capacity Population
❑ Layer
r boa S/y/ ❑ Non -La et
❑ Wean to Finish
C@ Wean to Feede
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ TurkeyPouets
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made'?
Design -C
Cattle YCapacityPo
❑
Dai Cow
❑
DairyCalf
El
Dairy Heifei
El
Dry Cow
❑
Non -Dairy_
El
Beef Stocker
El
Beef Feeder
[IBecf
Brood Cod
I
[Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: p — ypy Date of Inspection -2//.s/0-4—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:/
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No EU NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes T 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 W No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
�Cr�L�, L, rhC tr3 � iv f� f'Dn �, h�vk, . �%7�y,F� I/Zo.1e�t � ttn Cc�Qe>QrCJf CaQ i ►a a `:C
np f �tQLAroe.
Reviewer/Inspector Name �� r % Phone: S ,- we • /XW
Reviewer/Inspector Signature: Zd Date: .7
12/28104 Continued

n -
Facility Number- Date of Inspection /S/*
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 CA WMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
2 L Does record keeping need:improvement? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE?
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
A"dtittloua! Comments and/&FDrawtn "Y
12128104

,lVtSlOn OiW8tieer t2aahtyf
x�4, a.,- y t "---�-�.-.rr r i�L ♦-p �p T,- -^ xe za'- .� ems-
r "f�".}
:4 '-^r__..:.i. _.,. ._._ -... ...z._a:.: .- _:-.0-.-1_.. ,. a _. ..--_5'.�•-��c`_.._=_'�.. �.: �3-_;ti_..}a .e,.e e.._�rl ..:.a.=:.ar-
Type of Visit &6mpliance Inspection O Operation Review O Lagoon Evaluation
for Visit "0_1u ine O Complaint O FoRaw up Q Emergency Notfication O Other ❑ Denied Access
Facility Number Date of Visit: G O Time: = Od
rO Not Operational Q Below Threshold
awrg—fted ertified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ....6hoe;C fi-M.S-(,*w /VarS ....... _._ W ._....W County: ------
Owner Name:...... r � f � ...Fang. i...._-................................. ....� ....� �... Phone No: _. s Q Q .... r r,. L..................................... .
-Mailing Address:.. 30d l.'!ils!a--:...».».».. _. _m- il`h? /'1_.
Facility Contact: Title:
Onsite Representative:.
Certified Operator:,--_._ +-4e w it�•l__ ...__ .» ._�_�------
Location of Farm:
M^w eR Phone No:
Integrator-.
Operator Certification Number:
wine ❑ poultry ❑ Cattle ❑ Horse Latitude �' �� �« Longitude �• ��«
Diseha es & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ [�'Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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 floes+ in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑Yes ❑No
❑ Yes B o
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ETI�5­_
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O>e----
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .......... .....tt...................................................... ........_................. -....... _ . __..................................................... ........................ ....
Freeboard (inches):
12112103 Continued

Facility Number — Date of Inspection (� o
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ yes
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes [�}
closure plan?
Ko
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑<0
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes l lo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [rFo
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 21<0
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2<o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type { �TDLt ,.s T�—rt."CA& jS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yeses
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [04fv,
b) Does the facility need a wettable acre determination? ❑ Yes i?o
c) This facility is pended for a wettable acre determination? ❑ Yes 21 io
15. Does the receiving crop need improvement? [1 Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes B-No
Odor ]slues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes 81;r0_
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2rNoo
I9. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes 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 0 0
Air Quality representative immediately.
pConaments (refer to questoon ) Explain -any YES's�w rs and/or airy reeommcndabq or ley o ainmertes. r w ?;
Use drawl of feat/ to better Mtaati&6s ii* addite_nM_ as necessary ) .. f l
_ �y P � 3 r9 teld Copy ❑ Final Notes
• :r -._
1Ojer pat". SihM(, `�' OG 1 N psi Ci t f�OA
ACE.r-j; `Io Ar. J&CW;4 _Vf -Ail 414n
-S -,P 4L fla,c
J
. - -
ReviewerlIns ector Name
Reviewer/Inspector Signature` _ Date. 6 0
12112103 ,%- Continued

Facility Number: 10. — tzI Date of Inspection a 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0444
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Elo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
QbG
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�✓
(ie/ discharge, freeboard problems, over application)
❑
1q0
2T Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Leo
28. Does facility require a follow-up visit by same agency?
❑ Yes
P"o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
to
NPDES Permitted Facilities
30, Is the facility covered under a NPDES Permit? (if no, skip questions 31-35) aps
31. 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 NPDFS required formes need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

r . As!
Site Requires Immediate Attention: XJo
Facility No, w
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 2. , 1995
Time: & •`,VIi slims
Farm Name/Owner: Lahti .a
Mailing Address:[ SUSS
County:
Integrator: Phone:
On Site Representative: ar w f L*4 Phone:
Physical Address/Location:
Type of Operation: Swine --� Poultry Cattle
Design Capacity: _ lam_ al t-a_ Number of Animals on Site: _ -74o /Za'
DEM Certification Number: ACE DEM Certification Number: AC W
Latitude: Longitude: a "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of I Foot + 25 year 24 hour storm
(approximately I Foot + 7 inches) Qor No Actual Freeboard:�_Ft. _Inches
Was any seepage observed from the la o n(s)? Yes or ®Was any erosion observed? Yes or No
Is adequate land available for spray? eor Na Is the cover crop a uate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS mini m a setback crite a. 200 Feet fro Dwe fin ' e or No
100 Feet from Wells? ` e or No
Is the animal waste stockpiled within I00 Feet of USGS Blue Line Stream? Yes or Io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or qq If Yes, Please Explain.
Does the facility maintain adequate waste management recgrk(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y r No
Additional Comments:
Inspector Wame
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event

Site Requires Immediate Attention:
(� Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: -7t�
;.�
Farm Name/Owner:
Mailing Address:_
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:
E
Type of Operation: Swine o-"O' Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: 2_ Ft. ,._Inches
Was any seepage observed from the la n(s)? Yes or Ovas any erosion observed? Yes or No
Is adequate land available for spray? e r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell'n a or No
100 Feet from Wells?r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oro
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ora
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(o If Yes, Please Explain.
Does the facility maintain adequate waste management reggrds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) l Jor No
Additional Comments:
Inspector;Kame
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

REGISTRkTION =ORM FOR ANIMIAI. FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a lieuid waste system, then tzis form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2L.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: ��a<i� �6 <,•1J ._ l"?L / ! `kr���r
Mailing Address: f 0 ee .*-'yo 0
County:
CAI $-)n _ r �- _ 7 _? 2 S!3-LY _
Phone No 9/0 59' Z;2:2
Owner(s) Name: '06 F -c/I,- -'J' -ems
Manager(s) Name V?'ft!-f "Pov.v.�v
Lessee Name: r!r
Earn Location (Be as specific as possible: road names, direction,
milepost,- etc.) 191-411k, ALA i5f�z It )
•jr
Latitude/Longitude if known:
Design capacity of animal waste management system {Number and type
c- confined animal (s))
Average animal population on the farm (Number and type of animal(s)
-raised) _ 5,9e) n(A
Year Production Began: /LD ASCS Tract No.:_ �7 7"
Type of Waste Management System Used: b o -
Acres Available for Land �pplicat rap�I Waste: 3 S
Owner(s) Signar-uze(s) DATE,

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