820536_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Soil and Water Conservation E3 Other Agency
W Division of Water Quality
14P Routine Q Complaint O Follow-up or Dwo inspection O Follow-ua of DSWC review O Other i
Facility Number
auy❑
Date of Inspection
Time of Inspection
.?D 24 hr. (hh:mm)
Registered Of Certified © Applied for Permit © Permitted K3 Not U eratronal
Date Last Operated:
Farm Name:.. ................... .... i!"i$....... t r�........ ............... ..-................
. County:.................
-0V?9 j ............................-
Owner Name: ...........................................L,Y1....................................-.....
Phone �To:............•.......•.�+
:r...9-. rte'...
Facility Contact:--.-,•,•••.�, .&n.,t•-•-••••.•1i. Title:
16 No
Phone No:
Mailing Address:.... �.�3.---"'°t:T ......-.-41 ,f.' -...........::
......... .................4��� �..... N— ...................... .....a
Onsite Representative:..................0N. 5 -. NC�i! z.... ....
. Integrator: ..................
���- G...... 5.......... -
Certified Operator,.w .....-•.,P4 --•--.. -lY�S
............... Operator Certification Number:....... _...
Location of Farm:
Latitude 0 6 46 • Longitude • 4 4°
""SWlne;4
rent:'...,
latron p Poultry&`
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder Soe>
❑ Farrow to Finish
El Gilts
❑ Boars
leK' O� LSgOons L
0
'o
7,
u Layer
auy❑
I. Are there any buffers that need maintenancelirnprovement?
❑ Yes
No
Non -Layer
;;
tEl�on-Dairyj
Discharge originated at: ❑ Lagoon [] Spray Field ❑ Other
s-- � .. ., ., to •. `PAyk
I:o: - -- -So .
16 No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Other
l0 No
c. If discharge is observed, what is the estimated flow in gallmin?
1 oiill De�ln l.apa�+Xby
d. Does discharge bypass a lagoon system? ((f yes, notify DWQ)
3 aF s,v
[' No
r" :Total 991
❑ Yes
[No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
r � k
W:
No
5. Does any part of the waste management system (other than lal;oons/holding ponds) require
❑ Yes
No
mai nten ance/i mprovernent?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
- ❑ Subsurface Drains Present ❑ Lagoon Area
Spray Field Area
❑NoLiquid Waste Management System
�'br
7/25/97
zip
k:f . auk.:'-f�: X•, x�?x',, h a
General
I. Are there any buffers that need maintenancelirnprovement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
VNo
Discharge originated at: ❑ Lagoon [] Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
❑ Yes
16 No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
l0 No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? ((f yes, notify DWQ)
❑ Yes
[' No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
[No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lal;oons/holding ponds) require
❑ Yes
No
mai nten ance/i mprovernent?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
T Did the facility fail to have a certified operator in responsible charge?
Cl Yes
No
7/25/97

acilittNumber: gg -- 53�
8. Are there lagoons or storage ponds on site which need to be properly closed?
0 Yes to No
,Structures (Lagoons Iolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Freeboard (R) .� »..° �r..��......., .. ..»..N.. ...... _............... .. » ».........�.�_._... ...................._._ ..... » ............................
10. Is seepage observed from any of the structures? ❑ Yes 0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 19 No
12. Do any of the structures need mainte3nanedimprovernent? ❑ Yes 19No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes XNo
Waste A lication nXI �&V►._49
14. Is there iealevidence of over application? Yes ❑ No
(If in excess of WW, or runo"enterin aters of the State, notify DWQ) l5. Crop type �.._...._ ........t SIIGSP ...... _._.
j__........ S_ ._.. _..�R!irl{._._.....�
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [XNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 10No
18. Does the receiving crop need improvement? 0 Yes q# No
19. Is there a lack of available waste application equipment? ❑ Yes [Z No
20. Does facility require a follow-up visit by same agency? ❑ Yes 10 No
21. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Pemdusd Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes V140
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
[:]: No:violations-or deFiciencie's:wer'enoted,dunrig this'visit: You;wiH reeei've•no• tirther
. correspondence about this;visit:•
6�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
}a�o".I
Date:

V
/'Sr-'
Type of Visit: Q'Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: F_70_,'_/77 Departure Time: County: S' �str-� Region:
Farm Name: G �'� �1 rs ry-y Owner Email:
Owner Name:ryr i S �1`d y Phone:
Mailing Address:
Physical Address:
Facility Contact: /9 Az= /"­ Title:
Onsite Representative: � 5 _­ I -y
Certified Operator: i r)-_. ?"'?T_ G
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
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?
❑ Yes To ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes L3 No
❑ Yes [3 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/412015 Continued
Design Curren#
Design
Current
Design Curren#
Swine
Capacity Pop.
Wei Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Da' Cow
Wean to Feeder
a[?D
]Non -Layer
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . $auI
Ga aci
Po
Non -Dairy
Farrow to Finish
Gilts
La ers
Beef Stocker
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
101
Other
Turkey Poults
Other
JS
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?
❑ Yes To ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes L3 No
❑ Yes [3 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/412015 Continued

Facili Number: - 3Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �l 3
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
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes �10 ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
F -714o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[3 -go
❑ 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
[T] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ErKo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [3-114o ❑ 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):-cam v
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E] -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
❑ Yes �o ❑ NA ❑ NE
❑ Yes E3"lq-o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ -1qo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 -go
❑ 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
E3 -114o-
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
0 Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ ] Flo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[jNo
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

jFaciHty Number; - (, jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [ej-f�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fait 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
Q -do
❑ NA
❑ NE
[] Yes
to
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
[] Yes Cl< ❑ NA ❑ NE
❑ Yes [�T"No [] NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[D` o'
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond [] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J'gio
❑ NA
❑ NE
33. Did the Reviewet/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
6 --No
❑ NA
❑ NE
i any:YES answer;
:essarv).
Reviewer/Inspector Name:
Revi ewerd nspector Signature:
Page 3 of 3
Phone: ` A?--3r)3-D vQ
Date:
2/4/2015

Type of Visit: (g'Compliance Inspection Q Operation Review (] Structure Evaluation U Technical Assistance
Reason for Visit: Qr9outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: gam- 7 + 7 Arrival Time: qp!3Departure Time: County:
Farm Name: _ [� u rS Owner Email:
Owner Name: 6�rn; j T; karCILZ Phone:
Mailing Address:
Physical Address:
Facility Contact: FYI M2e.---e_- Title:
Onsite Representative: Sir-• ��
Certified Operator: ; rn- 7 -r re -y
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: D
Integrator: ` 122
Certification Number:
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 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 FA No ❑ NA ❑ NE
❑Yes
DesYgn Current
W i�
Design
'y,
Current i'
,....
,�: Design Current
Swine
yGapacity Pop.
Wet. Poultry Ca'p�acity
Pop.
d Cattle Capacity Pop.
40
Wean to Finish
I JLayer I
Dairy Cow
wean to Feeder
Pr7
Nan -La er
Dairy Calf
Feeder to Finish
_
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Doul it Ca Paci
Po P.
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brand I
�, p
ter
,
Turkeys
`,i�' °ly.I� Pit. .
f
Turkey Points
,
Other
Other
n
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 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 FA No ❑ NA ❑ NE
❑Yes
0 N
0 N
0 N
0 Yes
0 No
❑ NA
❑ NE
[::]Yes ❑No
❑ Yes ® No
❑ Yes ® No
❑ NA [] NE
NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Ins ection: 9
— 1
4 No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
Waste Collection & 'Treatment
[] NA
❑ NE
maintenance or improvement?
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CANo
❑ 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:
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
13. Soil Type(s):
Spillway?:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes (LNo
Designed Freeboard (in):
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ®. No
❑ NA
Observed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
_
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EkNo
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
Page 2 of 3
6. Are there structures on-site which are not properly addressed and/or managed through a
0 Yes
E,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
EINo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R No
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
❑ Yes
4 No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [&No
[] NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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_)
�No
❑ NA
❑ 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): Ztt,n N jgL lru 7-y—'%%-ry-j
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
13. Soil Type(s):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes (LNo
❑ 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 C'm 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
4 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L4No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2—No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

jFacHity Number: Date of Inspection:
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 ❑ 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 [2.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues ~
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond 0 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 (4 No ❑ NA ❑ NE
[—]Yes [allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
Yes ® No
❑ Yes fR No
❑ Yes C�9,No
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
Use drawwgs aftf o question ft Explain any YES answers And/or any additional recommendations or "any, outer comments.
Use
Tara is $'- er toto better explain situations:(ase additional aaQes as necessary). :� y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r
Phone: '�'5a l 37
Date: �' — 2' / 2
21412015

i�t visit: �Lompliance inspection U operation Review U Structure uvaivanon U technical Assistance
Reason for Visit; outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1
Arrival Timer Departure Time: County: Region:
Farm Name:
Owner Name:,
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Kjo"-'- %1�aar� , Title: i �p��. Phone:
Onsite Representative: Integrator: 31LL 11
Certified Operator: Certification Number:
Back-up Operator:
Location of Farris:
Latitude:
Certification Number:
Longitude:
Design Current
[] No
Design
Current
Design Carrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity P.
Wean to Finish
Laa er
Dai Cow
Wean to Feeder G�
Non -Layer er
Da' Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Poul
Ca act
P•o ..
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pallets
Beef Brood Cow
Other
—.Turkeys
Turkey Points
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[N No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 21412015 Continued

[Facility Number: -'57Z, Date of inspection: `3t�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No © NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qq
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes Z 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 allo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 2 -Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes ta No ❑ NA ❑ NE
.(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CEfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload D 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): G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2[No ❑ NA ❑ NE
15_ Does the receiving crop andlor land application site need improvement? ❑ Yes L&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Ejg_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes F No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes fZ'No
❑ NA
❑ NE
Re(mired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes ,� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2, No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes� No ❑ NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: o — 1,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes jaNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ,S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EINo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
ENo
❑ 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
E. 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
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
[] Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
n No
[] NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ESNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C!['No
❑ NA
❑ NE
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '9/' —4_r3 --33C) Z)
Date: J5 Z)
21412014

Type of Visit: L.)-Compli nce Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: F+�'R 'tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: p County: Region: � lL)
Farm Name Owner Email:
Owner Name: Gi ,� ti �, r r �; C rG Y Phone:
Mailing Address:
Physical Address:
Facility Contact: eg / xY�/� /n Title: 74j ,J Phone:
Onsite Representative: Integrator:
Certified Operator: , k =� j f 'G y Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
12 Design 'Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C.apacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
„"`
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , i?oultr
Ca aei _
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
I ur ey Paints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any pari of the operation? ❑ Yes R No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes WLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: - Date of Ins eetion: l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): 3 �(
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
P1 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
J1Z 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
[0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ 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): dj&_'PP1 9 J 6L- (f)
13. Soil Type(s): J5u7F) / Ina fi � -
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 [�T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 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 14 No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ejg�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 FA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

"[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U1 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes E -No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Fel No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JB No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J, No ❑ NA ❑ NE
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 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 CAWW?
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 f5g No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes [4 No
❑ Yes QC No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any. YES-auswers':and/or any additional recommendations or anyother comments: 4' mt.
Use drawings of facility to better explain situations (ase additional pages as necessary). ,,
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/7014

li
iv-055of Water Quality
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:�,,I Arrival Time: .3 l7. Departure Time: _ L O County: �P� Region: �'D
Farm Name: (2-,J- G ! U%Sz- Owner Email:
Owner Name: T~/'} -I,_ r -c- y Phone:
Mailing Address:
Physical Address:
Facility Contact: 00
Qrr— Title:
Onsite Representative: �--�
Certified Operator: rr.. �i 2"YCY
Back-up Operator:
c. Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
Design Curren_ t
❑ NA
Design
@urrent
Design Currenlippillt
Swine
Capacity Pop.
Vet Poultry
Capacity
Pop:
Cattle CapacityPop.
We to Finish
La er
Dai Cow
Wean to Feeder
��
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
"'
".
Design
';';•
.._„
Current
Dai Heifer
Cow
Farrow to Feeder
D . P,o.ul Ea aci Po ._
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef FeederLEI
13oars
Pullets
Beef Brood Cow
-
Turke s
Other
TurkeX Poults
NJ
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 Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes
R1 No
❑ NA
❑ NE
Page I of 3 214/2011 Continued

Facility Number: $� - 3776 1 Date of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
allo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
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
RNo
❑ 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?
JRYes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
N No
[:]NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
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):rm Lila I D U_--
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 Ed No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EZ 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 Ej No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LZ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes { No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

I:
FacUity Number: - Date of inspection: r] J
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 CR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'! ❑ Yes 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 CZ 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 allo ❑ 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 [Z No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tilc 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 CA W MP?
❑ Yes
�a No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
B No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®..No
❑ NA
❑ NE
]rum G(/p►� --,— &.-r arrsf �-� %r. t ✓��.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9i'Al0.f 33M
Date: �1;49
21412011

I '.
Type of Visit: F�Com nce Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ;.3 a Departure Time:'. ci c7 County: �a-��p+�� Region: Fip—*0
Ad,
Farm Name: (f G N u i��S`� Owner Email: �
;� 1
Owner Name: VQ m, m; .�n�2'" �v,rc �/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: _�� Integrator: �lr-����G
Certified Operator: _ C y Certification Number: I "qallll
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges
° �'
g current
Dest n C
fiD sign
Current
Design Current
Swine
Capacity Pop:
Wet PoultryCapaeity
Pop Cattle Capacity Pop.
r f
Wean to Finish
La er
Dairy Cow
Wean to Feeder
70 d
Non -La er
Da4y Calf
Feeder to Finish
"°'° ` '
Dairy Heifer
Farrow to Wean
Design
Curreat
Dry Cow
Farrow to Feeder
D . P,oul , _
Ca acity
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
- -
Turkeys
Other
Turkey Poults
Other
10th—
Other
Dischar es and Stream Im acts
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'?
Page 1 of 3
[:]Yes W No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
[:]Yes ❑No
❑ Yes CRI No
❑ Yes 2�LNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
2/412011 Continued

Facili Number: 9' - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OLNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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
H 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
Q 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
[K No
[:INA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®,No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes & 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): �r
13. Soil Type(s): Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JR 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 IS No ❑ NA ❑ NE
❑ 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 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 U$ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Nn No E]NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LK No D NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: l l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gl No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo [,] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes & No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes $D No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
5�j 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
Cg 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
0 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
C&No
❑ NA
❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond [❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
[g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EgI,No
[] NA
❑ NE
to question #i): Explain any YES answervand/or any additional recommendations or any other
aeility to better explain situations (use additional pap_es as necessary),
f, , /J..' iveol-r— 9-, 0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: "-# 75-3100
Date: /Z_—':g
2/412011

4
-� - ' �visiaiiof Water Quality
Facility Numbe0 Division of Soil andMdteKWonsen,,ainon
0 Other Agency //
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — rrivai Time: [7 Departure Time: ; 3a County:, Region:
Farm Name: if 77—' All, P, --y Owner Email:
OwnerName: ; C S �i ���y Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: % 1��� c _ Phone:
Onsite Representative: Ste., Integrator: �f/�� -
Certified Operator: ti F j i ~� y Certification Number:% -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�x ��1:)estgn� Current
❑ Yes
�Destgn��Curretit '
Design Current
❑ NE
Cap ttyP P
Cattle Capacity
Finish
"�ean
La er
Dai Cow
Feeder ��'pc7
Non -La er
Da Calf
o Finish
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
Da' Heifer
o Wean
❑ NE
Uestgn= Current
D Cow
o Feeder
D . P.oul
�Ca city 1?0 .
Non -Dairy
o Finish
La ers
[] NA
Beef Stocker
of the State other than from a discharge?
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees 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?
❑ Yes [A -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
id the discharge reach waters of the State? (If yes, notify DWQ)
b. DDit
❑ Yes
D No
❑ NA
❑ NE
c. 1&the estimated volume that reached waters of the State (gallons)?
i§
I
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
(21 No
❑ NA
❑ NE
1
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ej No
[] NA
❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z 91-
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?
Z Yes
r o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
[R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [allo ❑ 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 Wind/ow ❑ (Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): C_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (5 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 allo ❑ NA ❑ NE
[:]Yes ®No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes [jLNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ 7,No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: /
1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes IR No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes [allo
[:]Yes ® No
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Cornments (refer to question #): Explain any YES answers and/or any additional recornmendations or any other comments . M,
Use drawings of facility to better explain situations (us e. additional pages as necessary). _, n
r �a ✓ � �/' r c� �—�-ssf[%f� "— va� �' %�l8 [.C� �a ��1� s i �-� �Df D w � �`/�'t��
Reviewer/Inspector Name: �� �r (,c y�/ --�— Phone:
Reviewer/InspectorSignature: Date:
Page 3 of 3 21412011

Type of Visit: (>a'Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: - Departure Time: County: Region:
Farm Name: �--[i ��ar5��r�/ Owner Email:
1
Owner Name: to G Phone:
Mailing Address:
Physical Address:
Facility Contact: aa,en In; e- n- Lr Gy Title: Phone:
Onsite Representative: Integrator:`j-
Certified Operator: _ya—" -e �j �rG' y Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (1 f 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 CR -No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Design
Current
Designt
❑ NE
Swine
EDesCurrerrt�»
op -
WetPoultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
r,> i> ] p
La er
Non -La er
Dai Cow
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
. D . Poul
Design
Ca aci
Current
Po
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"th
Turkeys
-
Turke Poults
Other
1041
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (1 f 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 CR -No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:)No
❑ Yes [R No
[:]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: $" - Date of Ins ection: — 7— //
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Ug -No
❑ NA
❑ NE
Spillway?:
❑ Yes
Eig-No
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):
❑Other:
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
[A No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
54 No
❑ NA
❑ NE
waste management or closure plan?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L!�No
❑ NA
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
lel No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[.] Yes
Jallo
❑ 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 E] Application Outside of Approved Area
12. Crop Type(s): /`Mal, / .9r1tI`S�,i�
13. Soil Type(s): o b u
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 (aNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 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?
Required Records & Documents
❑ Yes 0 No. ❑ NA ❑ NE
[—]Yes ULNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ug -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Eig-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
Z[ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
n No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L!�No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

I
,4 Facility Number: - 73= jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (RNo
= 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E§,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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes S -No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Jallo
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?
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EEg-No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
[-]Yes [K No
❑ Yes gLNo
❑ Yes ®..No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
ilse drawings.of facility to better,e�plaio: itu t o s (u a additional pages as necessary) recommendations ar any otlieracomineats.
omments (refer to ftExplain any YES answers and/or any additional
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2t2 `*73—.33bo
Date:
21412011

ivision of Water Quality �✓
FaCilitV Number (r Q Division of Soil and Water Conservation ,, u -x;920
�� [�?tber Agency
Type of Visit (a e6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ]�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ` / Arrival Time: [_g.','3 Departure Time: ! Q � County: Region;
Farm Name: r Owner Email:
Owner Name: 42 7G Lt -7- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:X91' r� Z'-
Certified Operator: 9224An�/-
Back-up Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude, = e =' = « Longitude: ='
Design Current
swine Capacity Population
❑ Wean to Finish
(9 Wean to Feeder177❑
Design m
Wet Poultry Capacity Population
10 Layer
Non -Layer I
D esign Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
D.NO
❑Turkeys
❑ NE
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Mio ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
D.NO
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: S3 Date of Inspection - g
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):---12
Observed Freeboard (in): .34
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S 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
59 No ❑ NA EINE
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?
19Yes
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ER No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s) 1)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ER No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
rONo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to.. question #). Explain any YFS answers and/or-, ecommendations,or any other COinments.�
Use drawings of facility to be tter explain situations. (lase additional pages,as necessary)•
n
J /n ne,1 4dafC AV p"
/L1rr�d G'
Reviewer/Inspector Name �" ¢,4 ./��" t "= Phone: �O`'33-33a0
Reviewer/Inspector Signature: Date: ! D
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
`a
'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropriate box. (l WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
ONo
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
[?jNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jo No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CkNo
❑ 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
V1 No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
13 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
J9
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�L 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
14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
59 No
❑ NA
❑ NE
A,ddrtional�Commerits and/or D�rawuugs'
12/28104
12/28104

Type of Visit Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: � ; Departure Time: l �.� County: Region:
Farm Name: G N erg Owner Email:
Owner Name: ��,g� - !^ _ ! Phone:
Mailing Address:
Physical Address:
Facility Contact: - Title:
Onsite Representative: G Y�s�/ _ Af2Eb=
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: ar'-4z�
107
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = u Longitude: = ° =
Design Current
Design C*urrent
E.No
Design Current
Swine Capacity Population
Wet Poultry Capitty Population
Cat#le Capacity Population
Finish
❑ Layer
❑ Da' Cow
to Feeder 9D'
❑ Non -Layer
❑ Da' Calf
r to Finish
❑ NE
❑ Da' Heifer
w to Wean
Dry Poultry
❑ D Cow
w to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Non -Dairy
Fto
w to Finish
La ers
❑ Beef Stocker
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
Non -La ersPullets❑
Beef Feeder
❑ NA
❑ NE
❑ Beef Brood Cowl
❑ Yes
❑Turke s
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turke Poults
El No
Number Structures:
❑ NE
❑
Other
of
12/29/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
El No
❑ NA
❑ NE
other than from a discharge?
12/29/04
Continued

t. Facility Number:&:1'31,Date of Inspection
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Waste Collection & Trvalment
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
:.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stntclure l Stntcrure 2 Structure 3 Stnicture 4
Structure
;
Structure 6
Identifier:
Spillway?:
Designed Frceboard (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
29 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?
Z_Yes
❑ No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markets as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C4No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
57No
❑ NA
❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN a 10% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5No
❑ 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):
0 !" w av—z4x-
�'�'-[. G'1_..�,C% Sc 1, rijr a vc. S/✓7er /� � � • ..,� G �`?'
,�G C c r -/f e� r 1-Y
Reviewer/Inspector Name
Phone: h :inn
ReviewerfInspector Signature:
Date:
�f' 1uzavt4 c.onunuea

Facility Number: tj Date of Inspection
Is
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropriate box. ❑ VVUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
it No
[:INA
❑ 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
Eallo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
f4 No
. ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ 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
O�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
[3No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Cflmments d/n D swingsrt ; ,,
AL
12/28104

I ti
Type of visit eJCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `�f� Departure Time: ��County: Region: 71��FD
Farm Name: G ttG J�� r: �'r5/_ _ Owner Email:
Owner Name: ,* i r /` [° Phone:
Mailing Address:
Physical Address: r�
Facility Contact: �121� �' T I eor `f/ Title
Onsite Representative:
Certified Operator: i vim__ _ ! e- Ce
Back-up Operator:
Phone No:
Integrator:'/�✓t
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
= Longitude: [_-1 o [_-1,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Desi n Current
�&No
D ign Current
❑ NE
VDesign Current
Swine
Ca ac,�ty Prop lation
Wet Poul
Capa ty Population
Cattle
..
Capa�criity Population
❑ Wean to Finish
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
iry Cow
❑ No
Wean to Feeder
0700 192M❑Non-La
er
❑ Daify Calf
❑ to Finish
El Farrow Wean
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
w'
El DaFeeder Heifer
❑
EINE
to
❑ Yes
Dry Poultry
❑ NA
D Cow
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Farrow to Feeder
JXNo
❑ NA
W_".
Non -Dairy
❑ Farrow to Finish
❑ La ers
Page I of 3
❑ Beef Stocker
Continued
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
__
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
V�
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ig No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JXNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:--�-� Date of inspection
JKNo
❑ NA
Waste Collection & Treatment
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo ❑ 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
$J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any or questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
[Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PlNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [R_No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
JKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
JKNo
❑ NA
❑ NE
x�
kQComments (refer to queshont#):I✓xpiain any YES answers gn 1 r} any recommcndatiods or spy outer comments
I'yn !.—' w it�i!4'�'r.'9.=�`}k'!l"`'i'3
iiUse drawtngs�of facility to better1explamGsit ations. (use additioq_alepgages asanecessary}:
Reviewer/Inspector Name �— ` ';, Phone: 6
Reviewer/Inspector Signature: Date: ��V
Page 2 of 3
1212"4 Continued

— Date of Inspection
Facility Number:
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 29No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3No ❑ 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
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 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
'U 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
❑ Yes
[9No
❑ 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
S 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
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®.No
❑ NA
❑ NE
Additional CRTTents'and/or Drawings:
Page 3 of 3 12/28/04

to
i
Division of Nater (duality S�G , 1111�
Facility Number Q Division of Soil and Water Conservation
Other Agency
lType of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: F227,3 Arrival Time: jt -)O Departure Time /fIgo I Coun '
Farm Name: ty ("�' NurS 5' Owner Email:
Owner Name: rI a rty Asn . C �� ►� G V Phnnp•
Mailing Address:
Physical Address: c�
Facility Contact: V i�•iv► 011 1 C T i c*f r �4 Title: Phone No:
Onsite Representative:`C�r/ D re- Integrator:
Certified Operator: 4 =42'x_ `( a /'G Y Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Region:
Latitude: = =I =" Longitude: = o = = W
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
Wean to Feeder 703 ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[I Yes 14No [I NA [I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes JS No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: �� — _�3 Date of Inspection ��7
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[K No
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONO
[:INA
❑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
0 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
,ANo
❑ NA
EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
&lo
❑ NA
❑ NE
maintenance or improvement?
Waste ApBlication
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 -No
❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 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 El Evidence of Wind Drifl El Application Outside of Area
12. Crop type(s) an! Ca S�B�ee MnL-
13. Soil type(s) 1($�
r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes
5.No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 9j16/ 3 0�
Reviewer/Inspector Signature: Date: Z/—/ —T
� 12/28/04 Continued

Facility Number: rA —53 Date of Inspection 12=
Required Records & Documents
19. Did the facility fail to have 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 PINo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9 No ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J9 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
[gNo
❑ 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
ER 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
[XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
7,2/28/04

j 11�
Type of Visit QKompliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit routine Q Complaint O Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visil: Arrival Time: i DD Departure Time: orf County: Region:
Farts Name: C_G Owner Email: /
Owner Name: � ii _�' �__ __ _ ' c r Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�yrr/- alaann Title: Phone No:
Onsite Representative: .�&e2%0= C /'P; Cr' -e_ L,/ Integrator: p✓'r.g _ _
Certified Operator: C r G y Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
.Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
-❑ Other
Back-up Certification Number:
Latitude: ❑ o ❑ ' = Longitude: 0 0 F_1' ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity, Population
PEII er
Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges S Stream impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Citrrent ?
Cattle Capacity Population .'
❑ Dairy Cow
013airy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F 1
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?
tit
❑ Yes D9 No ❑ NA ❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
fX No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12/18104 Continued

Facility Number: rpZ S3 b Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes L.No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R) No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
P No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
50 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
91 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
14 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
MNo
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift [:]Application Outside
of Area
AWind
12. Crop type(s)
13. Soil type(s) _B 0 f m
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
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
ANo
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
D9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R[No
❑ NA ❑ NE
6;Pj �--djr1yV
Reviewer/Inspector Name Phone
Reviewer/inspector Signature: Date: D (o
12/28/04 Continued

-� Facility Number:,—�� Date of Inspection
y
Re uired Records & Documents
19. Did the facility fail io have Certificate of Coverage & Permit readily available?
❑ Yes IN -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Addrtiobal .Commen#s abdUo% Drawings:
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
El Yes
No
El NA
El NE
❑ Yes
(0 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CKNo ❑ NA EINE
❑ Yes W No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes
;qNo
❑ NA
❑ NE
[:1 Yes
fi4No
El NA
El NE
12/28/04

7 .2-1 '- a r, j
Division of Water Q tality
FactTt�amber t �� Q Diviseon of Soil and Water Conservation'
Q Qther.Agenet.
Type of Visit ID Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (jO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:1.2-VI-619iArrival Time: �-�4 Departure Time: e. }r4a- County: .�i1A-t Region:
Farm Name: _[rp Y_• a <fl& r 3 er Owner Email:
Owner Name: 3-giL+►-. r r- R e vz q Phone:
iVlailing Address: *. y2-2 • vK e 4-Z 00/ L.l,`�L/Q C02,F3 Z -P
Physical Address:
Facility Contact:
Onsite Representative:: 6r i e i- oo M
Certified Operator: !l �t 1r -
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
lffWeantoFinish of O
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Title:
Phone No:
Integrator: r dj i4:2 r
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ { ❑ Longitude: = ° ❑ • ❑
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑Turke s
❑ Turkey Pou Its
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoekei
❑ Bccf Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (I f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [9'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[`No
[:INA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
12/28/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [j'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect.application? If yes, check the appropriate box below. ❑ Yes [9 -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
,1 2. Crop type(s) �& r u
-� 13. Soil type(s) jb o a
Facility Number: 4'2 —fid F Date of Inspection OS-2if-
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ANO
❑ NA
Waste Collection & Treatment
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
&No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Is there a lack of properly operating waste application equipment?
❑ Yes
[ANO
❑ NA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
g 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
O; No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4fi 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
[j2 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [j'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect.application? If yes, check the appropriate box below. ❑ Yes [9 -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
,1 2. Crop type(s) �& r u
-� 13. Soil type(s) jb o a
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ANO
❑ 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
Q'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
O'No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[ANO
❑ NA
❑ NE
er ezplarnMsitiiahous (e
Reviewer/inspector Name s Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

a -.
Facility Number: fol —,S3 Date of Inspection
Re up fired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [-Qo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ Other ��,/
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes 5! o ❑ NA ❑ NE
❑ V4w* Appliratiehs ❑ W4 and ❑ Westc-,da taysis ❑psis ❑ ❑ Annual Certification
❑ Rsift a ❑ Steeicirrg ❑ Grop-i� ❑ ns ❑ pections ❑ v++es�
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9Vo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
0 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
Ej rNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
[g -NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3wNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�10
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WM IP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2 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 concem?
❑ Yes
[9'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
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2,f�o
❑ NA
❑ NE
'9"�'3� �] -,, r .,.,.� A ,� .. �, veryµ � �ir�• X-. � ik' µ d � a
12/28104
12/28104

Facilitv Number . Date of Vicit: Time:
......�� Not O erational Below Threshold
Et?ermitted lid'Certiiied ❑ Conditionally Certified U Registered Date Last Operated or Above Threshold:
Farre Name: �C^ o_j 4( ut` jec?� County: 5Q&z0:24ej3
Owner Name: ✓dirrrrr,:e P 11 Phone No. !A!?
Mailing Address: ��.`Z o :SC -174,01X -O02 6'_$3,2g
cell
Facility Contact: 12 P" C2 eTitle: Phone No: ' cto-
Onsite Representative: Af,r 4
p �ur►�w�.'e ,�„�i^c �i Integrator;
Certified Operator: i'cciIn A° lyv Operator Certification Number:99le
Location of Farm:
EDSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " .Longitude 0 •
Design Current
Swine C'anacity Panulatinn
'ean to Feeder 0p0 GDop
Feeder to Finish
❑ Farrow to Wear
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑
Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Population
❑ Laver I Dairy
Ikon -Laver A Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons = ❑ Subsurface Drains Present ❑Lagoon Area S rati Field Area
Boldin Ponds I Solid 1<Liquid
Holding � - ❑ No Waste Management System
Discharges 8 Stream Impacts
I . Is anv discharge observed from any part of the operation? ❑ yes lffo
Dischar,e oridnated at: ❑ Lasoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
El Yes Elo
b. If discharge is obsen-ed, did it reach Water of the State? (if ties. notify DWQ) ❑ yes D'Vo
c. if discharse is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes 0.yw
?, Is there evidence of past discharge from any part of the operation? ❑ Yes El -Na -
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EJNo
Waste Collection & J(eatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes �0
Structure I Structure 2 Structure 3 Structure 4 Structure ; Structure 5
Identifier: )
Freeboard (incbes):
05/03/01 Continued

Facility Number: J? — S3
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
lel. 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?
Rgauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sanjPj r e7r4c} f
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p�
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes EWO
❑ Yes ❑KO�
❑ Yes Mwo
❑ Yes Q'46--
0 Yes D'tvo
❑ Yes Eallo
❑ Yes [ 0
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
E>O
[a -No
[�'No
[allo
RNo
❑ Yes EQ'Mo­
❑ Yes [3'No
❑ Yes [ . o
❑ Yes ®'Flo
❑ Yes [tE*o
❑ Yes QN0
❑ Yes ©-Tqo
❑ Yes Piq-
❑ Yes �o
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this vlsit.
yiyy'yy�FNq��l 11:i �� 1
Commentsl"(referto,questio© ##): Explain any YES answei[s andlor any'recommeiidations or aay ntherscomments. .,,'
r w
q[Iseldrawtngs of facdity+to better explain situations 4.5fe additional pagesas necessary): Meld Copy ❑ Final Notes
PIGns ¢� ;n57a// ru.� gu..ye.
!r 7 Some DTvs� UroS G�rO[Uy v^ /F�7F S,�F OT 1O9aoy *okl�rls A4,e
boi-orrt
IC4rrrt IOa�(s oaC�, fiPCo/dS %�•
crlE ive/% ;��
Reviewer/inspector Name /Yf- ( q a> -;
Reviewer/Inspector Signature: Date: 3 ' %
05/03101 Continued

Site Requires Immediate Attention:
Facility No. 8 z - S3`v
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: & -:5-7
Farm Name/Owner: 62VT.Z 4P — �a
Mailing Address:
County: .J
Integrator: Phone:
On Site Representative: Phc
Physical Address/Location: .S �z
.s'9y - s ->,-/
Type of Operation: Swine Poultry Cattle
Design Capacity: _,00lbv- FA% -dumber of Animals on Site: -5-2>0 r
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon h;;�
ufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)r NoActual Freeboard: Ft. Inches
Was any seepage observed from the la n(s)? Yes oa� Was any erosion ob,�' ed? Yes o No
Is adequate land available for spray? es or No Is the cover crop adequate? =e or No
Crop(s) being utilized: 4�1 .sz134,
-
Does the facility meet SCS minimum se back cnteria? 200 Feet from Dwelling e r No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l�o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o<
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (voluu a of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o o It
Additional Comments: _ fir' 6.=`7 -4� y.&= -m'
'7
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.