820545_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

0
Type of Visit: (:�rCompi' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: erRoutine Q Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: .- p Arrival Time: `_ GU Departure Time: ; QO County: t Region:
Farm Name: ���A /' hC-r/ �'�' _ Owner Email:
Owner Name:_ o-, CU l i r? Phone:
Mailing Address:
Physical Address:
Facility Contact: CI I I rL Title: Cjj,.Uh rd` Phone:
Onsite Representative: �� f Integrator:
Certified Operator: ��crc� Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Patiltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D . P.otrl
Design
Ga aci
Current
Po
Dry Cow
Nan-DaiLy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkSX Pouits
Other
Other
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 Q'7Qo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
0 No
❑ NA
D. NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes (3 -leo ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of Ins ection: —/
Waste Collection & Treatment
M 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f c?,`
[]Yes
I�]no
❑ NA
❑ NE
Observed Freeboard (in): !y4L
❑ Yes
E]' -No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
E] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
❑moo
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
E N
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4$ were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
N
7. Do any of the structures need maintenance or improvement?
❑ Yes
[r
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
214o'
❑ 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 �io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. p 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): Vn! "r-
13. Soil Type(s): et_v
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes to ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes <o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] "'o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[]Yes
I�]no
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E]' -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑moo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0"<°
❑ 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 [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Ejl�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesNo
[-]NA [—]NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[]� ❑ NA 0 NE
Page 2 of 3 2/4/2015 Continued

J
Facility Number: iiiate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E " oo ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ 10 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D -10'o ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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 D<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes El"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
E No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q�o
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
two
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]'No
❑ NA
❑ NE
f Comments (refer to question,#,)Explain any YES answers and/or any. additional recommendations o�rs:anytother comments.
I
Use drawings of facility to Better,°explain situations (use additional pales as necessary_ ). ,�,�,
Reviewer/Inspector Name:
Reviewer/Inspector Signator
Page 3 of 3
Phone: //ig
Date: _.g=.ze>{�f�
21412015

Type of Visit: taCoroutinne
ce inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: WOO Departure Time: ' 0-15] County: Region:
Farm Name: C-rq " _ . Owner Email:
Owner Name: /'_ t -;-'e ;.r g { O ✓l 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: /` _i:2= Cod; i '7 f Title: l,U ri Ir Phone:
Onsite Representative:Integrator:
loor
Certified Operator: �A Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design
Current
Swine- Capacity Pop.
Wet Poultry
aPo
Capcity p.
Cattle C apacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . PoWtr
C_a aci P,o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Turkeys
Other
i ur cy Poults
OtherI
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C..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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 7 of 3
2/4/2075 Continued

[Facility Number: JDate of Inspection: – J —
} Waste Collection & Treatment
`1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f!3 -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes .Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Spillway?:
❑ NA
❑ NE
the appropriate box.
Designed Freeboard (in):
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Z� No
❑ NA
❑ NE
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.)
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
CENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n 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 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn. etc.)
❑ PAN ❑ PAN > l0% 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): Y. C71
13. Soil Type(s): � i� ►u ---
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JqNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4!� 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?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes JZ 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 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 2/412015 Continued

IFacWty Number. Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:)Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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 CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[] NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑Yes (4No E] NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [;�-No
❑ Yes M-1 No
=bk
❑ Yes JR No
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/lnspector Signatur
Page 3 of 3
Phone:d'-�--�
Date: T` i
21412015

�?Y/fo
ivisio'n�o'f Water Resources
Facility Number ®- `jJ O Division of Soil and Water Conservation
Q Other Agency
Type of Visit:_om/pliance Inspection Operation Review O Structure Evaluation Technical Assistance
Reason for Visit: 11Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � ( Arrival Time: Departure Time: U,�County: Region:) =
Farm Name: �'a, ' G I / 1 �t ✓"
Owner Name: f Ga; Cd
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: �J^-�� / /J S Title: Phone:
Onsite Representative:Integrator:
Certified Operator: Certification Number: .3z"7
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? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes MNo [:]NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes [] No
❑ Yes No
❑ Yes Uj�No
❑ NA ❑ NE
[:INA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - S`1_5 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JANo ❑ 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): j
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 5a'No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
ELNo
❑ NA
❑ NE
waste management or closure plan?
[—]Yes
allo
❑ 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
J�gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®..No
❑ NA
p NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ 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
E[ No
[DNA
❑ NE
maintenance or improvement?
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Waste Application
No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
.2 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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): f�-e-rl-n 1 �J (�✓� Y1�� _
13. Soil Type(s): / tJi)'La
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 In No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ 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 Q No ❑ NA ❑ NE
❑ Yes E&No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
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
ja 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of inspection: %[
F. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fallo ❑ 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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes g4 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
g No
[:1 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
Z] 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
ZNo
[DNA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? I€ yes, check the appropriate box below.
❑ Yes
M No
0 NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LE No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
, M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
_0 No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signator
Page 3 of 3
9, Y33-
21412015

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: &I routine O Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: is Arrival Time: Departure Time: 0 . _1>01 County: Region
AV
Farm Name: C/'q h, s� i'rrti. Owner Email:
—�
Owner Name: Czlh H •-L C Phone:
if
Mailing Address:
Physical Address:
Facility Contact: r►/'G[ ; �� f� ,' I7 S Title:Phone:
Onsite Representative: Integrator: z
Z=f.Ora
Certified Operator: sir Certification Number: -..z
Back-up Operator:
Location of Farm:
Certification Number:
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 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 0 No ❑ NA ❑ NE
❑ Yes
Design Current
❑ NA
Design
Current
Design Curren#
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Eapacity Pop.
Finish
La er
Dai Cow
Feeder
Nan -La er
Dai Calf
o Finish
Dai Heifer
o Wean
L
D , PouI
Design
C aci
Current
P.o .
Cow
Non -Dairy
o Feeder
p
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [—]No
❑ Yes 54 No
❑ Yes ER.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

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

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No ❑ 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(cs) 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 DKNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes CKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
g 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
(K 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
RNo
❑ 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
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
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J21.No
❑ NA
❑ NE
Comments. (refer to,question #j: Explain any YES answers and/or any additional recommendations or any otlser comments k
Use drawings of facility to better explain situations (use additi4uaI pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone; 9,10—,133-3 TOO
Date:
2/4!2011

iype or visit: t7vompliance Inspection V operation Review U Structure Evaluation OTechnical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 411 Arrival Time: ! p Departure Time: 1 '3i? County:_ Region: rr— D
Farm Name: 01,69L% f_ Owner Email:
Owner Name: ", g b r 1 n Phone:
Mailing Address:
Physical Address:
Facility Contact: G %'Gtis l� [� O r, Title: 1qWq Yr Phone:
Onsite Representative: .57
Integrator:
_ Integrator:r- S� _
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes [::]No
❑ Yes ®No
[:]Yes ❑No
❑ Yes ® No
[:]Yes E4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E3 NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 1/4/2011 Continued
Des' Current ""x Design
Current4
Design Current
Swine
Capacity Pop. Wet"PaultryCapacity
Pop.
ig
Cattle : Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
t
n. x V-
Dairy Heifer
Farrow to Wean
�. - Design
Current
Cow
Farrow to Feeder
DPoul ' ,- @a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes [::]No
❑ Yes ®No
[:]Yes ❑No
❑ Yes ® No
[:]Yes E4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E3 NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 1/4/2011 Continued

• Facility Number: - = jDate of I"section:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
54 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
j] 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 JZ 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):/'� f�YCCS,.r•�!
13. Soil Type(s): SrCj-Lit!.hat.Vk
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? Yes i.— ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2 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 12 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ig 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 ®, 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
0 N ❑NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number:- Date of Inspection: /9f I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [aNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes []Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] 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 Eg-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ggNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[HNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C2.No
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
JgNo
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®--No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anyother comments
Use drawings of facility to better explain situations (use additional pages as necessary).
�j�,�t'Y.t �`�+s✓� �a� D�.f/dY' � �Tr-�d='i f�4` %P z6'"''T°
gYr�sw�a S/�'
Reviewer/Inspector Name: k:
Reviewer/Inspector Signature: '
Page 3 of 3
Phone: 97e -y 3�oa
Date:
2/4/2011

Type of Visit: ®'Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: i Departure Time: o ; o c7 County: Region:
Farm Name_� e aj. Owner Email:
17
Owner Name: _C' /`", ;,r `f e 43 r, Phone:
01
Mailing Address:
Physical Address:
Facility Contact: �r. �'��1 Title: �Q�hY/ f Phone: N
Onsite Representative: Integrator:
Certified Operator: 5�u� _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DischaEges and Stream Impacts
1. Is any discharge observed from any pan 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 RLNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: 4, 717—
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in): -3
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
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
Rg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
IN 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
f9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
E[ No
[DNA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z[ 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): ,c /Dvr�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/0T land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes f�j 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 ' 1 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Rewired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes r R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check [:]Yes C&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 S1 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54—No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Candnued

" Facility Number: KaILL - Date of Inspection:
=-
24.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
®No
[:]NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[�] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
[] NA ❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J( No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other commentst@o �
Use drawings of facility to better explain situations (use additional pages as necessary). m
w
Or k 8-t - L ;Pr0P
Reviewer/Inspector Name: �Y1rY �-C_ z:_ Phone: D = O ]c
OIF
Reviewer/lnspector Signature:
Page 3 of 3
Date: li — y— 7___ JQ 13.
214/2011

Fype of Visit:omplianee Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: &It utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Q ; County: gam- Region: ff�g�
Farm Name: �r I ry� Owner Email:
Owner Name: n% p ����; .t f Phone:
Mailing Address:
Physical Address:
Facility Contact: r-- .: �- C ►� Title: 06U/1 r Phone:
Onsite Representative: Integrator: f r -
Certified Operator: � � Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
^ a
Desi n
� � I l i��
Design�Current
Design Current
Swine
';z
` Capac ty Pop
Wet Poultry
Cap ttyP.op Cattle Capacity Pop.
, .
Wean to Finish
La er
- Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dw P,oultry
--
Desigr% Current
Ca aci �P,o .:
Dairy Heifer
Dry Cow
Non-DaLrX
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I jBeefFeeder
Boars
Pullets
lBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
--
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
❑ Yes E, No
[:]Yes Cg -No
❑ NA ❑ NE
0 N E] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

IN
Facility Number: - Date of Inspection:
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:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Spillway?:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
� No
❑ NA
Designed Freeboard (in): 1
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
Observed Freeboard (in): 7
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[&No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[allo
[DNA
❑ 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
J2 No
❑ 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
[�No
❑ NA
❑ NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
UNo
❑ NA
❑ NE
maintenance or improvement?
I l . 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 p Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): V ,.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r71 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 allo ❑ 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 ® No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[S 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
� 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
[&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tgNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection:
4� 24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [3 No [DNA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check F] Yes allo [3 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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field t-=� Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Yes ® No E] NA [] NE
F] Yes [Z No E] NA [] NE
❑ Yes [g No E3 NA [] NE
0 Yes CF,No ❑ NA ❑ NE
❑ Yes allo
Yes ® No
[:]Yes ® No
�NA NE
NA NE
NA [] NE
Comments (refer to question ft Explain any YES answers and/or a©y additional recommendations or any other cornmen-
Use drawings of facility to better explain situations (use additional pales as necessary).
,�/fli"tet Er, -e -"a F'1 rl al_� 0/ "� u»��e-�--
CI
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 5
2/412011

i:.
Date of Visit: Arrival Time: Departure Time: County:
Farm N2me_C�1"a'r C !�.`� �Q f I1'L. Owner Email:
Owner Name: C r a t °L Phone:
Mailing Address:
Physical Address:
Facility Contact: rr`O, l t� 0 j r ✓t ,5 Title: Q Lj/
Integrator: f z' S_�ECIT
Phone:
Region:
Onsite Representative:
Certified Operator: Certification Number: 1 a,?*�3 P2
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharaes and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued
Design Current
Design
Current.ZE
Design
Current
Et
Swine, = Capacity P.op.
Wet Poultry
Capacity
Pop.
_
Cattle Capacity
Pop.
Finish
La er
Da Cow
Feeder
Non -La er
Da' Calf
n Da' Heifer
rFeedcrtoFinish
o Wean
Design
Current
D Cow
o Feeder
D ;1P.oult .
-Ca aci
P,o
Non -Dairy
o Finish
La ers
Beef Stocke
Non-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.. "
Turkeys
Poults
OtherI
10ther
Discharaes and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility Number: - Date of Ins ection:
1
® No
❑ NA
❑ NE
Waste Collection & Treatment
[] Yes
© No
❑ NA
❑ NE
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
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EINo
Designed Freeboard (in): /1
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
Observed Freeboard (in):�
❑ NE
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
EaNo
❑ 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?
0—Yes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z[ 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
C&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes �No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _. U_&�)Utkjd'C �Dv c�Sr sr
13. Soil Type(s): J�jLz1{'u k-- T
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 fo No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R[ 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 Ea No ❑ NA ❑ NE
❑ Yes V. No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
© No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EINo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: Date of Ins ecHon: (y
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 permii conditions related to sludge? If yes, check
[:]Yes
ONo ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey F-1 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?
D Yes
C.No D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
[aNo D NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
[A No D NA D 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?
0 Yes
EQ No D NA ❑ NE
Ifyes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No ❑ NA D 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
[2S No [:] NA 0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D No D NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yes
®. No F] NA 0 NE
34. Does the facility require a follow-up visit by the same agency?
Yes
® No [:] NA ❑ NE
Comments:(refer to question#) Explain any YES answers and/or any additional recommendations or any other comments.'
Use drawings of facility to better explain situations (use additional pages as necessary). 0b �
7, oo- K TLf h
�i[ B� � v, 1, -5 �DUA l/ `'S J`-)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C Q P�T e- lot Z'M A
Phone: �20 3.3V0
Date: / 1
2/4/2011

0
Type of Visit,commppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Koutine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : O Departure Time: County: Region: FfRQ
Farm Name: _.n_.r-a 't /' Owner Email:
Owner Name: Co !) a-5 Phone:
Mailing Address:
Physical Address:
Facility Contact: G ,o ` n 'Title: Oa ri Phone No:
Onsite Representative: S 6(jrt -e- _ _ Integrator:
Certified Operator: ��"`-y Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: . . Latitude: = o =I=" Longitude: = e 0 I F-1 "
Design Current
Swine Fapacity Population
❑ Wean to Finish
❑ Wean to Feeder
Design Current
VS'et Poultry CapacityPopulation
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
❑ Dai Cow
II
❑ Dai Calf
❑ Feeder to Finish
❑ Yes
❑ Dai Heifer
W Farrow to Wean /
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
L]Boars
Pullets
❑ Beef Brood Cow
0 No
ElTurkeys
❑ NE
lhher
❑ Other
❑ Turkey Poults
❑ Other
Number Structures:
of
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
[IN E
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
{ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes [9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes R 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 R No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ERNo
❑ 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 R10
❑ 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 RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 17
I3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EXNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0-Yes ❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E&No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes VLNo
❑ NA ❑ NE
Comments (refer to question #) Ezplatn any YES answers and/or any recomm ndations orkany other commenfs
:.
Use draw tngs,of facility to better eaplatn situations (use addthonal pages asbnecessary)':'.
A.
,.ems: ..6—na
-;2
�
/10 V,-t._ (�
Reviewer/Inspector Name Y Phone: J3-_130
Reviewer/Inspector Signature: Date:
% Z%
Page 2 of 3 12/28/04
Continued

Facility Number: — Date of Inspection 19 :20 /t)
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMA readily available? If yes, check ❑ Yes EgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below: aYes tfffqo ❑ NA ❑ NE
RWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CO No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1XNO
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;RNo
❑ 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
CR No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerMspector fail to discuss review/inspection with an on-site representative?
ElYes
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Page 3 of 3 12/28104

Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
(94outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: ' J Departure Time: ; County: Region:
Farm Name: Y Owner Email:
Owner Name: .8��,,, Phone:
Mailing Address:
Physical Address:
Facility Contact: Cf -a- - • ` n Title: . )Y1.io ✓ Phone No:
Onsite Representative: �S'' �"�_ _ _ _ Integrator:Z
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm -
Back -up Certification Number:
Latitude: =0
=t 0 Longitude: = ° = = u
Design Current
DesigWrent
Design Current
Swine Capacity Population
Wet Poultry Capacilation
Cattle Capacity Population
El NA
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Nan -La er
❑ Yes
❑ Dai Calf
❑ Feeder to Finish
No
❑ Dairy Heifer
❑ Farrow to Wean
1E]
Dry poultry
❑ Dry Cow
Farrow to Feeder
❑ Layers
ElNon-Dairy
El Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
F=00ther
ElTurke Poult❑ OtherNumber
of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
[:1 No
El NA
[__1 NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
No
0 N
El NE
El Yes
No
El NA
El NE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection Sc Ureatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
structure I Structure 2 Structure 3 Structure d structure 5 Ssructurc 0
Identifier:
Spiilway'?:
X No
❑ NA
❑ NE
17- Does the facility lack adequate acreage far land application? ❑ Yes
Designed Freeboard (in): 141
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L?�No
Ohserved Freeboard (in): �'362
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;A,No
[INA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
$Z No
❑ NA
❑ NE
through a waste management or closure plan?
Of 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
X No
[INA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Da 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
X No
❑ NA
❑ NE
maintenance or improvement?
Waste..Appliwion
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
L1 NA
El NE
maintenance/improvement?
11. 13 these evidence of incorrect application? If yes, check the appropriate box below. [:]Yes 14No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure6ludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [I Application Outside of Area
12. Crop type(1�
s) .wtu. w
13. Soil type(s) . I fq — —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EKNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [9 Yes; o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', F-1 Yes
X No
❑ NA
❑ NE
17- Does the facility lack adequate acreage far land application? ❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L?�No
❑ NA
❑ NE
.Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
t^_ n W fl r f i1W e j i rt � p v I�c�rnu c�s,
Curr sp, � �tZ73
ReviewerAnspector Name
Reviewerllnspector Signature:
Phone: �w e 10
Date: --'r) 4'
f L7LO/V� 4V/Ili7ll[C((

Facility Number: Date of Inspection
Iter uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2K..No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ 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 ❑ 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
132LNo
[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
K No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I. No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�ff No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5d No
❑ NA
❑ NE
Other lssues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
i[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
[k No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
PSNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
iX No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A.
12/18/01

CT t�ivision of Water Quality
[Facility Number Q Division of Soil! and Water Conservation
0 Other Agency
Type of Visit 615ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CW utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '. V .D Departure Time: County: Region:_
Farm Name: Lo 4 a 0' W"_ Owner Email:
Owner Name: �' r` a �� Gy � � r rt 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: tn
� r a C_ &2 Title: Phone No:
Onsite Representative: Sct,U, _ Integrator:/msssr-
Certified Operator: 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
Other
❑ Other
Back-up Certification Number:
Latitude: 1--] o =I
=" Longitude: = ° [� . [=.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ 1_a er
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non-Layen_
❑ 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 maty -made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DIX Cow
❑ Non -Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowi
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C@No [INA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[INA
❑ NE
El NA
El NE
❑Yes
El No
❑ Yes
[9No
❑ NA
❑ NE
[:]Yes
J[No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (,XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [INA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ( 9
Observed Freeboard (in): � t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes JR 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 10 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? R Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JZ[No
❑ NA ❑ NE
maintenance or improvement`?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Pg"No
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs ❑ T'otal Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Croptypes)_1� .E� Z Qjur-,e` -5 Yj
---
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 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
EZ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/pr any�recommendations or any other comments
Use drawings of facility to`better explain situations. (use addttt ala' ges as necessary):'#
�x s
Reviewer/inspector Name Phone: DD
Reviewer/Inspector Signature: Date:[
Page 2 of 3 12/18104 Continued

Facility NMber: eA — Date of Inspection v"Dn
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2JNa
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
SNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EK No
❑ NA
❑ NE
33_
Does facility require a Follow-up visit by same agency?
❑ Yes
(,No
❑ NA
❑ NE
Comments and/or Drawings:
1,2/28/04

I
A
ma
015�iv_ision of Water Quality
Facility DumberS J 0 Division of Soil and Water Conservation !�
Q Other Agency
Type of Visit ompliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit040--u-tine O Complaint O Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date orvisit: Arrival Time: €7fl Departure Time: • D County:
Farm Name: C t tl) 9- 011 i n ,j 4::,a V rte Owner Email:
/� [
Owner Name: a Phone:
Mailing Address:
Region:
Physical Address: I
Facility Contact: L- CA I 1 rl j Title: Phone No:
Onsite Representative: l/��-.-r.P Integrator: FL- -
01
Certified Operator: S Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: El =' ="
Longitude: =° =4 [="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder -3
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
0 Non -Lavers
[] Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischary-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Design Current_
Capacity Population
1 } 45
Number of Structures: 1)
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?
[I Yes KNo 0 N El NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NF.,
r
0 N
El NE
El Yes
❑No
❑ Yes
®,No
❑ NA
EINE
❑ Yes
ER No
❑ NA
❑ NE
11/18104 Continued

Facility Number: — S Date of Inspection?
[9 No
❑ NA
❑ NE
Waste Collection & Treatment
RNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
94 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes
MNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Desigmed Freeboard (in):
Observed Freeboard (in): A f 26-
5.
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
5& No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
® No
[1 NA
❑ NE
maintenance or improvement?
Waste Avulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IS No ❑ NA ❑ NE
maintenance/improvement?
] I _ 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, 2;n, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5a No ❑ NA ❑ NE
15- Does the receiving crop and/or land application site need improvement? ❑ Yes I No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[9 No
❑ 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
[ No
[INA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
I S& ai�S
y, e)L) t.00zs
AWti
'_
ReviewerAnspector Name Phone: % �-M3 3,00
Reviewer/Inspector Signature: I Date: — �T—
Il/28104 Continued

Y
Facility Number: — Date of Inspection E
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. ❑ W`UP ❑ Checklists
❑ Design El Maps ❑Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No [INA ❑ NE
ES 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 IN No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5Z No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ 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
t3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
91 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
54No
❑ NA
❑ NE
Comments and/or Drawings:
12/28104

A
Type of Visit (!';routine
ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason Tor Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 13�Arrival Time: , qa Departure Time: r County: �'�-' Region: F. f/
Farm Name: G ra � n 1 i j r1_ � �r M.- Owner Email:
Owner Name: G v�, i M S Phone:
Mailing Address:
Physical Address:
Facility Contact: C ; 2= C-0 I/ ; n,5 - Title:
ill
Onsite Representative:
Certified Operator -
Back -up Operator:
Phone No:
Integrator: %lit /V�3f _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = 0Ig Longitude: =0=1 =
t
Design Current
❑ Yes
Design Cum Design C►urrent
Swine Capacity Population►
Wet Poultry
Capacity 'Population Gattic Capacity Population
❑ Wean to Finish I
ILI Layer ❑ Dairy Cow
❑ Wean to Feeder I
ILI Non -Layer
❑ Dairy Calf
Feeder to FinishDairy
CK No
Heifer
❑ Farrow to Wean
ul
Dry Potry
�' ❑ D Cow
29 Farrow to Feeder
❑ Layers
A"`' Noa-Dairy
❑ Farrow to Finish
7
e ❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑Boars
❑ Pullets
`''
❑Beef Brood Cowl
--
Other�
❑ Turkeys
❑ Turkey Poults
- . -
_
❑ Other
❑ Other
�` plumber of 5lruetures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
❑ Yes
RjNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
CK No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
DQ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
7
71
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
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection �U{o
Do any of the structures need maintenance or improvement?
❑ Yes
�&No
❑ NA ❑ NE
4.� Waste Collection & Treatment
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA ❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
.® No
❑ NA
❑ NE
•r Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
10.
Spillway?:
❑ Yes
Pq No
❑ NA ❑ NE
Designed Freeboard (in):
11.
Observed Freeboard (in): J
❑ Yes
No
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
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?
14.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes
�&No
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 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
Pq 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)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t4 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
14 Yes
❑ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
IVI No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA ❑ NE
%S. 14' C911,0s �pr��{� �r[.o1 s`i�'/rn�► wvrk,c haJ+o&_4-W L. n.k r-'eLJ
(,[l �tl,Pvt :! LCJotS e J— H ixu t ej I I► i 6 l i rpt r `til a5 ,i1,M'',,n� 7k d - ;i� e bre, �
3urr' y -e-. �"i)er't `rS tL-` i!nyr �rYjrtcu/a�c `Yo t�fi� �-�7►t c PQ''L,.
TYcitn,r'a.+�5 plc. `rte ,�y,,.l �,,,,� I�,pH r' f�J.�►- j �D y v,t Ca�,.��a:5kr� rrlrr' �4��rua�%plC�
r
r/Inspector Name �-�. Phone: r/Inspector Signature: Date: fl
12/28/04 Continued

• Facility Number: — Date of Inspection �b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ANo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;3 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
EINE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
[:1 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
U&No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
N 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
ER 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
(R 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
f KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ayes
No
❑ NA
❑ NE
w
Addttitional Commeuts4ndldr Drawings w'
CV r�li:f �a
r
0r-SPM7 1
Ifts, Ct`�'�'�- gall
��l
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ denied Access
Date at'Visit : ro -%� Not Time:
Faeility Number ,Z S
Operational Q Below Threshold
O'Permitted [3 -Certified [r Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .....C.t !f .......0a�� ..._ !:.^2....„......._._....._ ........»... County:
Owner Name: _ C!»�,�......CD//1 1!?SWW... » _. _ _.. _ ._._.,... Phone No: „�ls 1;- 3 �t1 .. _._. ....._. .
-mailing Address:.mlril----_. _._ � .... ...
Facility Contact: .._.. tCf - - CG'I1✓� .5......._...._......._._Title:.._..........- ».. Phone No:
Onsite Representative: ---L -ra� ..... �gZl 'n S ... ___W__ .._.._. Integrator: IJ - _...__ ____.__--
II 1^�s._.. -
Certifiied Operator:._.„„ 6,cjp:.9......... Operator CertificationNiiinber:,_,
Location of Farre:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` 4 44 Longitude • ° 0«
Discharges & Stream IMRacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes
b. If 'disobavee is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Io
c, If discharge is observed, what is the estimated flow in galfrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EJ40
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9190
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0440
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EK0
VFAa f Structure 1 Structure 2 Structure , Structure 4 Structure 5 Structure 6
Identifier: .......� r..... ............ .....................
Frechoard (inches): `] It
12112103 Continued

FacilityNumber: jU
Date of Inspection �Q-O
5. Are there any immediate threats to the integrity of any of the structures observed? (ief trees, severe erosion, ❑ Yes (�
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes ONo
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? ❑ Yes 0410
8. Does any part of the waste management system other than waste structures require maintenaneerimprovement?
❑ Yes
bjNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
Waste A Iication
10. Are there any buffers that need maintenance anprovement?
❑ Yes
a4oz
H. . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ts1Xo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
Cf&")
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
52fgo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
&leo
b) Does the facility need a wettable acre determination?
❑ Yes
Loo
c) This facility is pended for a wettable acre determination?
❑ Yes
leo
15. Does the receiving crop need improvement?
❑ Yes
Bow"
16. Is there a lack of adequate waste application equipment?
❑ Yes
Levo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes GWo
14. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O -Wo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes E4
Air Quality representative immediately.
Copy ❑ Final Notes
4ad a cp'es{r p,-, lk' 4/?R -.2 a4aJ_ C"4" n
�sptfer w l' or T`aX,
Re v; e u,rd
w' -A A". Ca/l,'.rs 4he GO oda role o6�,1` a.c,Jle 4-10/rs;s
Planrfi� f Lr / f` fhb t�rc%,
;5 c-ve1/ !(epi,
Reviewer/Inspector NameG+rl�
Reviewer/Inspector Signature: ' 1 ,vof Date:
12!12/03 [,ontrnueu

I
Facility Number: g a —5 tri Date of hrspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis [] Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Oleo
❑ Yes El -Wo
❑ Yes OW -6
❑ Yes G -MO
❑ Yes O -W
❑ Yes E W6
❑ Yes [9 -No
❑ Yes QW0
❑ Yes fllWo
❑ Yes O -No
❑ Yes ❑ No
d Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditiadal
12/12/03

Site Requires Immediate Attention: �Q
Facility No. NIA
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: Cr o-;
Mailing Address: 207- k
County: Su••s,eSCIAI
Integrator: Prx.s >'
On Site Representative:—
Physical Address/Location
DATE: l y 1$ , 1995
Time:
i ,.r 5 % C. -,g ra Col/�/s
A rro w h c a.d - t✓ � +,v-i-�
-z832
<fcr.�•rs ��c • Phone:
C 1/0-)
-5"V 2.
-- 57 71
Phone:
(9192
5_32
— 445S4t 9
SR 12-11 %z w.: c fro.•.
4Gt
NG
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3&4 port cc�d Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hav& sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) GD)r No Actual Freeboard: 3 Ft. D Inches
Was any seepage observed from the la oon(s)? Yes o No Was any erosion observed? Yes o No
Is adequate land available for spray? Dor No Is the cover crop adequate? Yes or No
Crop(s) being utilized: GT-at55
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? Yes r No
100 Feet from Wells? es or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(N)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(s)
Is animal waste discharged into water of the 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 (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es or No
Additional Comments:
Ri � Re.VeaS
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.