820517_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental auai

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine 0 Complaint O Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region:
Farm Name: r� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: TaME.S [&" Title:
Onsite Representative: 4
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: Yr"ST�g�
Certification Number: 17794
Certification Number:
Latitude: Longitude:
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
❑ Yes F, No ❑ NA ❑ NE
0 Yes [] No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ Na 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)
2. is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ,® NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued
Design Current
Design
Current
Design Garrent
ty Pop.
Swine CapaciIM
Wet Poaltry
Capac yh
Pop.'
Cattle Capacity Pop.
Wean to Finish
I Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -La er
D Poul
I I
Ea ac'
L?o
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other, r
Turkey Poults
Other I
10ther
4
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
❑ Yes F, No ❑ NA ❑ NE
0 Yes [] No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ Na 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)
2. is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ,® NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of fns ection: 2
4aste Uollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
`T❑No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
;0 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure S
Structure 6
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site winch are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
1P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
tq No
[] NA
EINE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste A lication
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 Wi ow ❑ Evidence of Wind DrijI I Application
Outside of Approved
Di
Area
T : ;►�^- rT ks C J iso •
12. Crop Type(s),
�'"'
13. Soil Type(s): A4_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No No
r
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
FL4 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
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfal I inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Condnaed

Facili Number: Date of Inspection:
,Z4. Dict the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
213. 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes, No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
El Yes IV No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
E] Yes
1�No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
0 NE
Somme©rs trercr�io quesnon g). explain any r r.a answers anwor any aaatttonat recommenuanoos ar aay orper cammenrs.
' "sc., i+� III M;Sf�dl7 �. F' =i i'=u tl, '� _�. °i, ill s �I' Jul, �'
Use di-awinsof faci[xtytohelter explain situations (use additional pages," necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
z14�0'1s

i ype or visa: i uompuance inspection V uperauon tceview V structure Lvatuatron lJ t ecnnicai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! QQ,.- Departure Time: /O , County
Farm Name: POwner Email:
Owner Name: Preci- QQ, �tO5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L(
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: FAD
Phone:
Integrator: �S
Q7700
Certification Number: r
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes IFNo ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
[DNA ❑ NE
Page I of 3 2/4/2011 Continued
Design Current„r �g
Desi n
Current_ W
Des' n Current
Swine
Capacity Popes. ��tv ettPoultry Capacity
Pop. -
Cattle Capacity Pop.
Wean to Finish
Layer
-
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
��' i '�
,-iF�_
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul @a ` act
PoP.
INon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes IFNo ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
[DNA ❑ NE
Page I of 3 2/4/2011 Continued

Facilt plumber: -15 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Struc e l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No P] NA ❑ NE
Structure 6
❑ Yes K, No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ YesNo
❑ 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 Sneed maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
1�d 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 Evidenc W i D ft AOutside of Approved Area
�12.
CropType(s):�Zja S
'
13. Soil Type(s): 2K:�
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FnNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facili Number: - 7 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [)9 No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesNo
[—]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
05 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E�$No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[9 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:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: b I b
2/412011

iye of visit: w t-ompnance inspection v uperatnon meview U Ntructure r,vaivateon v 1 ecnnicai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County;/����
^" Region:
Farm Name-.,.
ame: — Owner Email:
Owner Name: S��sl�.e �s Phone:
Mailing Address:
Physical Address:
Facility Contact: '% tYlu �.6; yvt� Title:
Onsite Representative: rr
Certified Operator: ;?-44
Back-up Operator:
Location of Farm:
Phone:
Integrator: wrgr/ `L
S -Q--
Certification Number: V -7 7007
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poul
Ca a
P,a
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Dther
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)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes M No
❑ Yes 1p No
�NA ❑NE
® NA ❑ NE
ONA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412014 Continued

i
Fackfi Number: - Date inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes ❑ No ® NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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
EP No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0 No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[S No
D NA
E] NE
S_ 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)
17. Does the facility lack adequate acreage for land application?
❑ Yes
4. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
the appropriate box.
11. is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofNZ5,1
i'❑ Application Outside of Approved Area
12. Crop Type(s): ca? -5--4i a4 cl-WS S _' "Z �� l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EpNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�JNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [-]Yes [�3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes [� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Efl No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: 7�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . Pq No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes�No [—]NA E] 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fi@
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
[:]Yes W No
0 Yes [] No
❑ Yes E] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments .(refer to question ft Explain any YES answers. and/or any additional recommendations or any other commen0"'PrV
Use: drawings of facility to better explain. situations (use additional pages as necessary). .:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �1�r13j7-33J
Date:
214/1014

type or visir: w Lompuance inspecnon C..) Vperation Keview V structure Evaluation t...) lethnical Assistance
Reason for Visit: * Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f00 Departure Time: p/ i County: Region:
Farm Name: —q 9— Owner Email:
Owner Name: 2r -f l LL v►' 5 aq�- C, Phone:
Mailing Address:
Physical Address:
Facility Contact: Z'ctVV'0� Ly -.3o Title:
Onsite Representative: 4
Certified Operator: Z" 0 re_vxc, n
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 'Pr8$��
Certification Number: q ( i 700
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No E] NA [:]NE
[-]Yes ❑No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
❑NA []NE
(DNA ❑ NE
Page 1 of 3 2/412011 Continued
Swme
Wean to Finish
Wean to Feeder
Design-
Caacr
Current t
Po
Wet Poultry
La er
Non -La er
n
Capacrty
Current ,
Pap y
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
�''
_
::, `f
Dai Heifer
Farrow to Wean
�
Q
Design_
Current
Cow
Farrow to Feeder
Farrow to Finish
D , P,oultry
Layers
'.Ca ati
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
T .
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No E] NA [:]NE
[-]Yes ❑No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
❑NA []NE
(DNA ❑ NE
Page 1 of 3 2/412011 Continued

[Facility Number: Dateof Ins ection: I 1
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: I
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 3� N
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
QM No ❑ NA ❑ NE
❑No ®NA ❑NE
Structure 6
❑ Yes VM No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes §@ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to bave the Certificate of Coverage & Permit readily available?
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑WUP []Checklists El 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 I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rnp No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Tj�p No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: $2_- Date of Inspection: S
3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C@ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
` No
❑ NA E]NE
the appropriate box(es) below.
i� T
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
[:]Yes
[!p No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [5g) No
❑ Yes G+No
❑ Yes M No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �VP
21412011

Division of Water Resources
Facilify Number ®- I "3i Q Division of Soil and Water Conservation
`�'�� � Other Ageacy
ff
of Visit: Compliance inspection Q Operation Review O Structure Evaluation Q Technical Assistance
n for Visit: O Routine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: 0 'AD County: 34V0570rl Region:
Z Owner Email:
le
Facility Contact: (��.+�.Q,S La" Title:
u
Onsite Representative:
Certified Operator: ;?4C4{ ae_"
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: TI005A
'T
Certification Number: 9?7%00
Certification Number:
Longitude:
Design Current;
Swine
Capacity Pop. - Wet Paintry
=Design Current
Capaeity Pop.
Design Currenf
Ca#tle Capacity Pop.
[] Yes
No
Wean to Finish
❑ NE
[ZLayer
Da Cow
❑ NA
Wean to Feeder
Non -La e r
Da Calf
.
Feeder to Finish Da Heifer
Farrow to Wean a `'` - '� Design Current D Cow
Farrow to Feeder DtY )Paul Ca arity Pio , Non-Daizy
Farrow to Finish Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
r!!!—1
Turkeysx
Turke 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?
Page l of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No [�] NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
[] Yes
No
❑ NA
❑ NE
[]Yes
PD No
❑ NA
❑ NE
21412014 Continued

t Faci1i Number: Date of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure l Structure 2
V It
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
P No ❑ NA ❑ NE
❑No VgNA ❑NE
Structure 6
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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
�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
rb No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[nNo
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑)~ailure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ac tables Crop
` Window ❑ Evide of Win Drift E] Application Outside of Approved Area
12. Crop Type(s): F�f Fes^gs�'i'1
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 M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes §a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
T�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
[INA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists D Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [::]Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
FQ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
FANo
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Facili "Number: - Date of Inspection: ) L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
� No
E] NA
[:]NE
❑ Yes
(M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P3 No ❑ NA [D NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Jam} No
❑ Application Field E]Lagoon/Storage Pond F-1 Other:
j`�
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
Comments (refer to ggesdon #): Explain any YES. answers and/or. any additional recommendations or. any other comments.
IN
Use drawings -of facility"to_-better'explain situations (use additional pages as oeccssaryl. l
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q Lal �y3 7.3'4 o
Date: IQ
2/4/2014

type of visit: 4P Compliance Inspection U Uperation Review U Structure Evaluation U leclinical Assistance
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: "z;3O Departure Time: vl ,00 County:—►`4wj
Farm Name: `moi"^'s� Owner Email:
Owner Name: S C f Phone:
Mailing Address:
Physical Address:
Region: JQ0
Facility Contact: f<CLX)C" Title: Phone:
Onsite Representative:( S (�'f-v1ij Integrator: _ 1�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
111 Swine
Design Current-
Ca acf r TM. � ;.,".
p ty r Pop aM Wet Poultry
Design
Capacity
Curreat x
Pop.
Design Current
C""Rttle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow .
Farrow to Feeder
D , Poult
Ga aci
Po
—Dry
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes q No ❑ NA ❑ NE
❑ Yes ❑ No [P NA 0 NE
Ej Yes [:] No [V NA ❑ NE
❑ Yes [:]No
❑ Yes T] No
E] Yes fiD No
NA ❑ NE
� NA ONE
Ej NA ONE
Page I of 3 2/4/2011 Continued

Facili Number: -rj Date of Inspection: Z L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3u -
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes eW No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0 No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LFJ No
❑ NA
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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 E]Evidence of Wi d Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (I� i-�M� 6Z14S.,S`
13. Soil Type(s): AU
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes P No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
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
0 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
Eja No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard p Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LFJ No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

• Facility Number: -5 12-1 jDate of Inspection: I -z-
24.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E ] No [DNA ❑ NE
❑ Yes F] No ❑ NA ❑ NE
❑ Yes f] No ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: Lo-
�33­33OD
Date: q& 2-
2/4/2011

i ype of visit: W Compliance Inspection V Operation Review () Structure Evaluation U `Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: i pOQ.t� Departure Time: QST County:
Farm Name: "'�-�'� ' Owner Email:
Owner Name: �l,Qs/t�Vt Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:`
Certification Number: %7 99
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CPNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes C] No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes ❑No � NA [:]NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CQ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

:acili ., dumber: - Date of Inspection: 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jo ❑ 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
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
[) NE
waste management or closure plan?
• If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?]
Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
D PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence riLnDrif�l ❑ Application Outside of Approved Area
12. Crop Type(s): 4_.q.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'V] No
❑ Yes 1P No
❑ NA ❑ NE
❑ 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. Docs record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 214/2011 Continued

.\
Facility Number: 9F2 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes P�jNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #f): Explain:any YES answers and/or any additional recommendations or=aany other-comtnieuts.
Use'drawings of facility to better explain situations (use additional naQes as necessarv).
! " �e U S 14 odt i7s` �l
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/412011

i_
Type of Visit 41 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:D Arrival Time: Departure Time: County:
4_14iA
Farm Name: Owner Email:
Owner Name: !'ns c, Phone:
Mailing Address:
Region:590
Physical Address:
Facility Contact:.r - Title: Phone No:
Onsite Representative: L6 m lntegrator:Tneg-�a V=
f�Certified Operator: Operator Certification Number: r ! l
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =10 1:1 = Longitude: =0=' = u
J
Design Current
Designs Current
nt
Design CurrePP
Swine C►apacity Population
Wet Poultry Capacity Popufatiott
Cattle Capacity Population
[P:NA
❑ Wean to Finish
10 Layer
❑ No
❑ Dairy Cow.
❑ NE
❑ Wean to Feeder
❑ Non -Layer I
❑ NA
Dairy Calf
❑ Yes
❑ Feeder to Finish
❑ NA
❑ Dairy Heifer
Farrow to Wean
pry Poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
El Beef Stocker
Gilts
Non -La ersPullets
❑Beef Feeder
8:1 Boars
ElBeef Brood Cow
ElTurkeys
Other
❑ Turkey Points
❑ Other
❑ Other
Number of Structures:
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?
❑ Yes [ *o ❑ NA ❑ NE
❑ Yes
❑ No
1P NA
ElNE
F-1Yes❑
No
[P:NA
❑ NE
❑ Yes
❑ No
hNA
❑ NE
[--]Yes
!qNo
❑ NA
❑ NE
❑ Yes
tg)No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

F•..Fility Number: Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural fireeboard? ❑ Yes ❑ No �6A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier'
JB No
Spillway?:
❑ NE
Designed Freeboard (in):
❑ Yes
Observed Freeboard (in):
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No El NA [:1 NE
(ie/ large trees, severe erosion, seepage, etc.)
0 No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
PNo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
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? ❑ YesNo
EP ElNA ElNE'
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
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
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�T 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 a25 -W `� �� (PagW 5th. LMt.,i'
type(s) I
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JB 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NF
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
P"'J' t �t �� q�N�"o
Reviewer/11nspector Name „ -
, Phone: a
Reviewertinspector Signature: Date: D
Page 2 of 3 12/28 4 Continued

• Facility Number:Lig - Bate of inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21 .
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Pa No
❑ NA
❑ -NI-
E❑
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
ElWaste Transfers
ElAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections--
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
!. No
❑.NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ No
P NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 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
a] No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes F
No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�] No
❑ NA
❑ NE
Additional;Comments an[llor;Drawings:
A.
Page 3 of 3 12/28/04

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I COX�_ I Departure Time: County: N Region: al —
Farm Name: DP -L A r- -
Owner Name• 1 fps 1'�V 1'►�SG
Mailing Address:
Physical Address:
Facility Contact: RWA4 btf-40-r- Title:
Onsite Representative: Ci_ Lail
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: Pr�s-4�QP_
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
[=4
= Longitude: =0=6 o=6
Design Current
Design Curren#
Design Current
❑ NE
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ NE
❑ Wean to Finish
❑ Layer
NA
❑ NE
❑ Da Cow
O'No
❑ Wean to Feeder
❑ Non -La er
❑ Dai Calf
❑ Dai Heifer
❑ Feeder to Finish
99 Farrow to Wean
Dry Pauitry
❑ D Cow
❑ Farrow to Feeder
—
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
❑ Gilts
❑ Boars
O#her
Turke Poults
FO Other
Dumber of Structures:
r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gg)No ❑ NA ❑ NE
❑ Yes
❑ No
9NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
r No
❑ NA
❑ NE
12/28/04 Continued

J
Facility Number: - j Date of Inspection
Waste Collection & 'Freatrrrent
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure i Stntcture 2 Structure 3 Structure 4 Structure ; ..tructur4 6
Identifier: I
❑ Yes
Spillway?:
❑ NA
Desiuned Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): _ 1
rL No
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.)
No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes�No
El NA E] NE
through a waste management or closure plan?
❑ Yes
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
1I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Auulicalion
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes`{�
No [JNA El NF
maintenance/improvement?
T
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
):No ❑ NA ❑ NF
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evtden f Wind DC1rift Application Outside of Area
l
12. Crop ty1 ( s) S m Gi ss �P / , 5M . "N ' dt trw&
13. Soil type(s) y{-,,+y-_ly ;
0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rL No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question t#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 9
Reviewer/Inspector Signatures&6iDate:
12128104 ionanuea

Facility Number: — pate of Inspection
Required Records &.Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes 5,No ❑ NA ❑ NE
❑ Yes d4No ❑ NA ❑ NE
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes TjqNo ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
No
❑ NA -
❑ NE
❑ Yes
❑ No
Y9 NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
❑ Yes
JP No
❑ NA
❑ NE
❑ Yes
❑ No
1PNA
❑ NE
❑ Yes
t No
❑ NA
❑ NE
❑ Yes
(6 No
❑ NA
❑ NE
❑ Yes
[t No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
EL No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
11/28104

Type of Visit *Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit * Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: f JuT! I Arrival Time: S y Departure Time: .••, County:
Farm Name: t0— q°Z Owner Email:
Owner Name: �� r'� r "tea -C r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: integrator: `pevs
Certified Operator -
Back -up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: r9
Latitude: = 0 0 = " Longitude: ❑ o ❑ t
Design - Current
❑ No
Design' =C went
Design Current
Swine C•apactty. Population
Wet Poultry
Capacxi�tyP p lation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
P9NA
❑Dai Cow
❑ Wean to Feeder
J0 Non -La er I❑Dai
❑ NA
Calf
❑ Yes
❑ Feeder to Finish`
Ponitry
❑ NE
❑Dairy Heifer
❑ D Cow
Farrow to WeanDry
Farrow to Feeder
❑
ElNon-Dairy
❑ Farrow to Finish
N -L
❑ona ers
❑ Pullets
❑turkeys
10 Turkey Poults
❑ Other
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
t.
Number of Structures:
❑ Gilts
❑ Boars
:.::.....::... ::.-
❑ Other
Discharees & 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 Stale? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes PNo El NA El NE
❑ Yes
❑ No
la NA
❑ NE
❑ Yes
❑ No
O NA
EINE
❑ Yes
❑ No
P9NA
❑ NE
❑ Yes
IN No
❑ NA
EINE
❑ Yes
?z No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Numher: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NoNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 tructure 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 ❑ 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 '951
No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo [_1NA ElNE
(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 [:1 Yes No El NA [:3 NE
maintenance/improvement?
]L . 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 i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift /❑ Application Outside of Area
12. Crop type(s) C"( rrr,4 �wass is 5PA^ C9-�A,tI
13. Soil type(s) A-� Y d { ({ -AAA
1
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
FNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
15INo
❑ NA
❑ NE
Reviewer/inspector Name r f ;; Phone:�i/0 33"f
Reviewer/inspector Signature: Date:80-1 LA
Page 2 of 3 12128/04 Continued

Facility Number:Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
F] 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
NNo
❑ 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
h No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R3 No
❑ NA
❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
nNo
❑ 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
ZnNo
❑ 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
P9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Page 3 of 3 12/28/04

' ty • Division ofWater lity V�1�
Facili Number � -JL�r i'"f I Q Division of Soil andd WWater Conservation
-- Q Other Agency jQ Z
Type of Visit * Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: Region: P010
Departure Time: County: g -
Farm Name:
Owner Name: f e
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 7"C" Title: Phone No:
t~ T f LiTtL _ Qt,
Onsite Representative: integrator.
Certified Operator: Operator Certification Number -
Back -up Operator:
Location of Farm:
Swine
Wean to Finish
Back-up Certification Number:
Latitude: ❑ o =1' ❑ Longitude: =10=1 = u
Design - Current Design Current
Capacity Population Wet Poultry Capacity Population
s ❑ Laver
i JEJ Non -La et
L[ Feeder to Finish
Farrow to Wean
Farrow to Feeder j
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Dry Poultry
Non -L.
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.:
Cattle Capacity Population .
❑ Dairy Cow
❑ Dairy Calf.
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker �.
❑ Beef Feeder
❑ Beef Brood Co
j
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
❑ NoA
❑ NE
❑ Yes
[INo NA
❑ NE
❑ No, NA
❑ NE
❑ Yes
❑ Yes
Ai�jqo ❑ NA
❑ NI:
❑ Yes
)9No ❑ NA
❑ NE
12128104 Continued

Fanility 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. 1f yes, is waste level into the structural freeboard? ❑ Yes A No ❑ 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 o ❑ NA [INE
(ie/ large trees, severe erosion, seepage, etc.) //
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ANo ❑ 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes We ❑ 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 OM. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )XNo ❑ NA [IN E
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 A% ori 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop indow [:]Evidence of Wind Drill El Application Outside of Area
Com►'`
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,K)No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PoNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes 4No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _ObNo
❑ 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):
I
A,
Reviewertinspector Name Phone: L
Reviewer/Inspector Signature: Date: q
12/28/04 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Mo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )RpNo ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '13 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes , o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No t5NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )JNo
[--INA
❑ 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 bNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No `1P NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes AN.
❑ 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 Wo
❑ 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 ONo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes "kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes -)4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�x C' c� n
!2/28/04

I Type of Visit d&'L;Routine
mufiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q 06-1 Departure Time: Coun"
Farm Name: P— + D- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
RADL�v ELIY_d!I�CA
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region: !�0
Location of Farm: Latitude: 0 0 = =6 Longitude: ❑ o =I
= u
Discharges & Stream Impacts
Design Current
-Design_ Current
Design
IM
Current
Swine
Capacity Population
R'et Poultry tCp arty Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
El Yes
❑Non -La er
❑ Dai Calf
❑ NE
❑ Feeder to Finish
El Yes
-
❑Dai Heifer
arrow to Wean;
c. What is the estimated volume that reached waters of the State (gallons)?
*'
Dry Poultry .:
❑ D Cow
❑ Farrow to Feeder"
"`- ;,
Non -Dairy
❑ Farrow to Finish
f5_5A
❑ La ers
❑ Beef Stocker
❑ Gilts
NA
on -Layers
❑ Beef Feeder
❑ Boars
No
❑ Pullets
❑Beef Brood Cow
Other,
❑ Turkeys
El Turkey Poults
s a
❑ Other
I
❑Other
Nuin Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�,
I�J�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
,,_, f
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El�'J No
,A
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
f5_5A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ YesNo
NA
El
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Faci ity NumbeDate of Inspection �Ja� 7ldp_J
❑ Yes
B? No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
S No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
dNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ENA
❑ NE
St cture 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
VNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
VNo
❑ 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
environmental7eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
No
El NA
[I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5�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 W4 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R"No ❑ NA ❑ NE
maintenance/improvement? R/
1 1. Is there evidence of incorrect application`? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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) jnla�iQ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B? No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
S No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
U/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
{- —ter., !� -.xF, `
Reviewer/inspector Name t a �, .: ® _ ' ,..r Phone:
Reviewer/Inspector Signature:, Date: a9
Page 2 of 3 12/28/04 Continued

f . �
Facility Number: — Date of Inspection /b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [jrNo ❑ NA ❑ NE''
❑ Yes [440 ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El
Weather Code
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 K
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
UNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[I Yes
[►]'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EfNo
❑ NA
❑ NE
27,
Did the facility fait to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eNo
❑ NA
❑ NE
Other Issues
2$. 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
1rJ 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
CdNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
ElYesL�
No
E(
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
El✓J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

SF02 H 571
Type of Visit @Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine Q Complaint O follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Vll 710j- Arrival Time: of : /,S Departure Time: County: _ 5aw. A_.ionj_ Region: FQQ
Farm Name: POwner Email:
Q
Owner Name: + r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative-
� PC %,I coNj - any �k integrator: 1 ee.s-�aa r_
Certified Operator: Q U G pr e--- o -k- Operator Certification Number: 17'7T&
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: =0 =6
=" Longitude: =o =1 ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Laver
❑ Feeder to Finish i —
® Farrow to Wean iS 7 2 ,�;'
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑
Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current-.
Cattle Capacity- Population.
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dr
y Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes.. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
[:1 NA
El NE
❑Yes
0 N
❑ Yes
® No
❑ NA
❑ NE
❑Yes
®No
El NA
❑NE
12128/04 Continued

lFacility Number: g a —517 Date of Inspection
�—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure. Is Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _'�' _ %///y/9
Observed Freeboard (in):�1R"`.' --
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes [NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes M 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 9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes ®No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1P+ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) r m ig PC,ro u / OS
13. Soil type(s) 1914
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
rq No
El NA
❑ NE
17. Does the facility lack adequate acreage for Iand application?
❑ Yes
5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D No
❑ NA
❑ NE
/- r, ke .57 y-1 f'P �YGVl�.U7 err-.) �O+iJ G "0 ---Cx -N
'C1Ow. t_3 e, r�cv,'� .q
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone:
Date: �1
12/28/04
�d7/6-7-
Continued

Number: ga — 517 Date of Inspection �
27 -
[Facilityr-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes m No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes © No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the ap ropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
© No
❑ NA
EINE
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
m No
❑ NA
❑ NE
25. 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
[0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E' 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
m 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
Qa No
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
A�kional Comments and/or Drawings:
D9— Rer-+o.rc, pl,� oe" aoQ oQ.��osc e
12128/04

i
Type of Visit 9 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit i Routine O Complaint Q Follow up Q Emergency Notification Q Other © denied Access
Facility NumberS Date of Visit: - GY Tune: C2
O Not Operational Q Below Threshold
UR(ermitted Deer ifiied U Conditionally Certified 13 Registered Date Last Operated or Above Threshold: —
Farm Name n
....._..._.........__......P.�.----�-........_..........� _............_............ County...._:S�G.�.�17..h...._._____...._ .. r�..�...
Owner Name: �%'e fad _......... �q rm 5 _ Phone No: c.cf1 P.-----�r?..`Z.
Mailing Address: ^... :. ! .... X ...... -? 11 M f r�n! Q/ I , ,�,t� C - 2 3 �_ 1
Facility Contact: ......... at e �af Title:........... Phone No:
Onsite Representative: ...... Rtl .......' are &Qf ........... ...... .......... Integrator:-+<•••� ? .� --_W . �_..
Certified Operator:_ �, OSs /��'>{e rso y �a yd 7
--_.....I...... .........._- _...._.___ _ _.W W_._ .,-- Operator Certification Number:
Location of Farm:
E wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • 6 94
Discharees - Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes 61,No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)❑yes -Iqo
c. If discharge is observed, what is the estimated flow in gal/min? f_�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑wo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EgNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ElYes 0,410
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ......
Freeboard (inches):
121,,12103 ��r__ Continued

! Facility Number:
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A RRfic2tiOn
10. Are there any buffers that need maintenancehimprovement?
❑ Yes EKo
❑ Yes [Ko
❑ Yes [moo
❑ Yes [x -Ko
❑ Yes jXo
❑ Yes [}No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑,Ko
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C DU;�ar� ';Mal Q C_'&.4 - -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑W55
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
1$. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [-#o
❑ Yes O No
❑ Yes Flo
❑ Yes ONo
❑ Yes M Vo
❑ Yes [3 -No
❑ Yes ElNo
❑ Yes ©moo
❑ Yes ❑-K
Cammenfs {rder to gnesaan #) Explain an YES answers and/or aunt' recommeadat<ons ar aaypther comsnettts.
:Use drawuags oifsc>lity w hauteur explain sttnatzoaj. (ase ad�Ltvnal 'I B� !?') ' geld Copy ❑ Final Notes
Reviewer/Inspecwr Name
- -.
ReviewerAWspector Signature: Date:
12112/03 Continued

t
• Facility Number: Date of Inspection D-0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWIVIP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EgNo
❑ Yes [-Po
❑ Yes C3 No
❑ Yes [3NO
❑ Yes [9-1�o
❑ Yes M No
❑ Yes Go
❑ Yes DNo
❑ Yes 63,No
9 -Yes ❑ No
❑ Yes [9 -No
❑ Yes [4No
91�res [:]No
Q,Yes [:]No
❑ Yes EkKo
No vio4ations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
sttonal Comments autd/ar h3rawrngs
X33 argC/ # 3`I r'T/', Sare&7' J5Tcrle- c/ 74, Z ri 7'Ae Gfrir �cAf S�ua���
S cIr SPI 4 �-4 e cot 11'6ralj n 01C e4'aSre irel��ol/CCA Ir'a P C/ L/
Gt/ a [drr' .6 P
Fcr,- rh %ply s y a oc�
P e cords 16,41 9 ood
T
12112103

Site Requires Immediate Attention:
Facility No. $2 -`
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address: /(1( 4I L S S f eZEE I--
County: 341 Al
Integrator: C i� 1<,� t�� �t��� Phone:
On Site Representative: - Phone:
Physical Address/Location: 01q We, 0 Lvlrev a &c -AA lC�ta.�
Type of Operation: Swine P/ Poultry Cattle
Design Capacity. Number of Animals on Site: O ( -sow
J= o
DEM Certification Number: ACE DEM Certification Number: ACNEW !�
Latitude: Longitude: a to SP - x`23 - o
Circle Yes or No A �
Does the Animal Waste Lagoon h v sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)(Yq& or No Actual Freeboard: Ft. Q inches
Was any seepage observed from the agoon(s)? Yes or WWas any erosion ob? Yes ory
Is adequate land available for spray? es/617No Is the cover crop ad ate9 vor o
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? O or
Is the animal waste stockpiled within I00 Feet of USGS Blue Line Stream? Yes or o,)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orQ
Is animal waste discharged into water ore state by man-made ditch, flushing system, or other
similar man-made devices? Yes or d If Yes, Please Explain.
Does the facility maintain adequate waste management recon s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTH CPIROLI W► DIKPARTMMM of $ EMMLTR & XATVAAL RESOURMS
DIVISION OP ENVIRONMENTAL
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
;�•w-�'�.Lwy�,�,'.,1.... -^e.::: .':::..:-e-w- ^r ,vY �� - �
PARK f 1.
All
.x. r.r°^ isC.::�+...�i�!',,,.w'i�.,^�`iv'=:^:x"vii: io:. ^- .or•e«>,�w.�vo��,i e' ye:,,.:_: `.: �...
x IiJSgEQIOi►T'1'E FAAPI. iyillID;�
John limen ic, fJohn D. Mckm
.... w•' ...:..• _ .qa�r 5'`' •+` "..'."".' .a°wa�Ft+'.':`�.`.:r`... �w�.,»r..,.ry�,n ...l±h - r..`_.
yF'.�x.•.n,•[W o�M_K� iN..VL�ir, AY:70� _Y
-MG
I(6 Illi s S hntD Z83Z8
(9 rv)SGa-
3
7@11—
Ail questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal ration Qi'r(�V11
Horses, cattle, wine poultry, or sheep
SECTION II
iW© • �.
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,080), .and
poultry (30,000 birds with liquid waste
syst4m}j
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CgBt p
BASTE XA1UGEM3WT PLAPP
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility Meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

field sit2 Mangaement
1. 7a animal wa6W aLesekpilAd Or lagcmoa
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigataA wi+-Mn 25 it. of a UCGO Map
Blue Line Stream?
3. noes this facility have adequate acreage
on Which to apply the waste?
4. Does the land application sits have a
cover crop in accordance with the
M31FiCATzort PLAN?
5_ Is animal Waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
5. Does the animal Waste management at this
farm adhere to Best Management Practices
(BMP) of the approved C OTMCA170M
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _)
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SE
Commen t

COW
lkL
40,
00
lop
40
10 40
IdII 11 -2 40
From Clinton take 24 west
to Roseboro turn left on
Hwy 242 at traffic light.
oe GO to stop sign turn right
go I mile turn right again
at 411/242
Junction go 2.3
miles farm is on the left.
/

REGISTRA7: N FORM FOR ANIMAL e DLOT CR E?A710NS
Deparzzent ofEnviranment, Health and Natural Resou ces
Division of Environmental Management
Water Quality Section
if the animal waste management system for your weed? oL cce,acion
is
designed to serve more span or
equal to !00 head
o; cattle,
75
horses, 250 serine, 1,000 steep,
or 30,000 birds sat
are served
by
a liquid waste system, =en this
Rrm :;gust be filled
cut and mailed
by December 31, 1993 pursuan= ==
_SA NCAC 2H. 0217 (c)
in c=de_ to
be
deemed permitted by DEM. ?-ease print clearly,
a NameL:� �L�',
Mailing Address: : 1 1) 0-L.?W-115I K��
rt_ 1I' I 'T C': 1.i &'ir — — 7
gone No. _S4t2 - 7
Owner (s) Name: �,i1n�Ri,,'t��fTC/i 7.',= -- _
0anacer (s) Nacre
Lessee Name:
Farm Location (Be as specific as possible: _sad names, direction,
milepost, etc.) :'PKE AL4 W. F'?,c-t, CLLR&
r-tj t11..1\1 AU1, �T�, LrG�r; . ri i K c rC7 <` S,C_,J Cir r rvi,z+g n rQry
Lat_=ude/Lcngi *,de if known:
t
Design capacity of animal waste management system (Number and type
c_ czn_ined animal (s)) Cl
Average animal population on ;Me farm (Number and type of anlmaal (s)
-raised) Sog-m r-- As- ...�.2Q.
_r" 1 T -act e1
Year Prodc:cticn Regan:x 194 RSCS Tract No_ :><
Type of Waste Management System Used:
Acres Available for Land Application or Waste: a
owner (s) signature (s) :A 'I, P'?
X v OATS
V=13