820580_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai
n -V

i ype of visit; yy uompnance inspectuun %,j wperation review V structure Evaivanon V i cennicai Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: W?A/dVikrrival Time: Departure Time: County:
Farm Name: 14 p� Owner Email:
Owner Name: 114 nf_ Phone:
Mailing Address:
Physical Address:
Region: /-
p
Facility Contact: �}72� ��(7�y�E Title:' ,hone:
Onsite Representative: �'�C Integrator:
Certified Operator: VSI� log✓ Certification Number: Z2i Z/
cation
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes QNo [DNA ❑ NE
❑ Yes 0
No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes foNo [:]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?
age 1 of 3 2/4/2015 Continued
Design Current
Design
Carrent
Design Carrent
s{_
Swine
Capacity Pop.
Wet PouHry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
I
Cow
Wean to Feeder
Non -La er
I
Calf
Feeder to Finish
j
"'
i
Dairy Heifer
Farrow to Wean
Design
Carrent
Dry Cow
Farrow to Feeder
-
D . Poul
Ga 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes QNo [DNA ❑ NE
❑ Yes 0
No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes foNo [:]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?
age 1 of 3 2/4/2015 Continued

i
Facility Number: 617., - 5,Q7 I JDate of Inspection: PO /114✓
Waste Collection & Treatment
y 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: ATC.
Spillway?:
Designed Freeboard (in): ZZ -1 ti
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 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 ❑ YesNo [:]NA [:]NE
maintenance or improvement? P
Waste ADDlication
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 [i No
❑ NA
0 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): 650'MV7A
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes PPNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

y
Facility Number: - D Date of Inspection: AMr9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 Reviewerl nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
1N GUS F1 -1k4 -"6C_
A "4 X, � /'
'e
Reviewer/Inspector Name
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
Phone: 671P, -� , �J-&
Reviewer/Inspector Signature: J� r l/t�' _ Date: Py - fav Z'fP' ?
Page 3 of 3 21412015

— /F"G — Q
Type of Visit: O-Compl' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
'ifle]
Date of Visit: // Arrival Time: `, o� Departure Time: County:
Farm Name:/ PP Tom! r;3-z'-� f—ar^r)-� Owner Email:
r
Owner Name: e i I./o%_ �Y_ �,�/� C'� Phone:
Mailing Address:
Physical Address:
egion:
Facility Contact:Title:-- 4 Phone:
Onsite Representative: Integrator:
Certified Operator: f� �5� C �� l ;r,� Certification Number: 19 y f? 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignCnrnent
❑No
DNA
Resign Ctat nt
❑Yes
Design Current
0 N
Swine ' Capacity
Pop.
WsPouliry
Capacity Pop.
Cattle Capacity Pap.
Wean to finish
Layer
Dairy Cow
Wean to Feeder
I
jNon-Layer
Dairy Calf
Feeder to Finish p
/
'
Dai Heifer
Farrow to Wean
Design'" Current
Cow
Farrow to Feeder
D , P,onit ,
Capa ,. Po
—Dry
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
boars
Pullets
Beef Brood Cow
-,
Turke s
Other
Turkey Poults
Other
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 allo ❑ NA ❑ NE
❑Yes
❑No
DNA
❑NE
❑Yes
❑No
0 N
❑NE
❑ Yes ❑ No
❑ Yes CRNo
❑ Yes QG No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: Z
Waste Collection & Treatment
❑ Yes
MNo
❑ NA
❑ NE
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure Structure 3 Structure 4
Structure 5
Structure 6
Identifier.
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
Spillway?:
I8_ Is there a lack of properly operating waste application equipment?
❑ Yes
[SNo
❑ NA
Designed Freeboard (in): ;Zk 9640� f g
Required Records & Documents
Observed Freeboard (in): 15-/ 31,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fQ No
❑ NA
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.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[A No
❑ NA
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
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
Page 2 of 3
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
VLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes La.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): �! V4
13. Soil Type(s):
14. Do the receivingcrop�om those designated in the CAWMP?
❑ Yes
MNo
❑ 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
[ANo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
I8_ Is there a lack of properly operating waste application equipment?
❑ Yes
[SNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fQ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[A 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
K No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VLNo
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility Number: RZ - Date of Inspection: aa1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ca No ❑ NA ❑ NE
e
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 0. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
2$_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes KNo ❑ NA 0 NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
PLNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[&No
❑ NA
❑ NE
{ i gs.of facility to be k p ;, - ;,P� } , ry) .
drawn tter ez lain si#uattons use add�t�onal es_'as uecessa;?^
74 1
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 90-50--e91,3_1
Date:f �� l
2/412015

(Type of Visit: (A'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit:outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 L Arrival Time: (7.', Departure Time: County: p r. Region:
le
Farre Name: :Liz S/ f r�P.Sq�gWst f ry� Owner Email:
Owner Name: r�dcc f /Y -r5 �pY.. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: f1 Integrator: ' 59�i�tI�
Certified Operator- jam" z-- / ;;" Certification Number: !�- �% o %
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
CurrentDesign
Pop.
Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
D P,oult ,
La ers
Non -La ers
Pullets
Design
Ca aci
Current
I?o .
Dai Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Qther :
Turkeys
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [Z No ❑ NA ❑ NE
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 pan of the operation? Yes 500- ❑ 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 1 of 3 21412015 Continued

Fm ciflty Number: - Date of Inspection:
Waste Collection & Treatment
A. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA
❑ WE
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): ! -30
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
7 [No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F: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
CaYes
6
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fallo
❑ NA
❑ NE
maintenance or improvement?
1 I. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
eg-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop [] Evidence of Wind Drift ❑ Application Outside of Approved Area
%Window
12. CropTYPe(s)=�"1Yt1l�tct /hVr'l3rr�
1'
13. Soil Type(s):
14. Do the receiving crops d' er from those designated in the CAWMP?
❑ Yes
Eg No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tj�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�fNo
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design p Maps ❑ pease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f�j 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 �4 No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

[Facility—Number: - Ds ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ja No ❑ NA ❑ NE
i
15. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes fo No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;No
❑ NA
❑ NE
❑ Yes
S No
0 NA
❑ NE
[]Yes
allo
❑ NA
❑ NE
❑ Yes allo 0 NA ❑ NE
❑ Yes "No ❑ NA [:]NE
❑ Yes E?INo ❑ NA ❑ NE
❑ Yes allo
❑ Yes 54 No
❑ Yes �No
❑ NA NE
0 N ❑NE
❑ NA ❑ NE
oue t S iy'Z GU iTh L05 -e � /�G[�r-fi r �;111-.117
Reviewer/inspector Name:
Reviewerflnspector Signatui
Page 3 of 3
Jt�r,
3 03_0)-�--C
Phone:ZZ& — jrj
Date: %/—/
21412015

i -..;z 'I6
Type of Visit: ampHance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Izeason for Visit: (Dl outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Il—tel Arrival Time: Departure Time: : 3Q County: Region:
Farm Name: U4oy %Z'.!�!�S e'"�. _�Q I r►� Owner Email:
Owner Name: C I UQ ��/�� Phone:
Mailing Address:
Physical Address:
Facility Contact: f e'v/ mpor e- Title:
Onsite Representative: ,S e-�
Certified Operator: X -030-r- l E=re/4
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: _/;;I 0
Certification Number:
Certification Number:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Sagacity Pop.
Wet Poultry
Capacity
Pop.
Cat10ltle Capacity Pop.
a. Was the conveyance man-made?
Wean to Finish
Layer
[—] NA
❑ NE
Dairy Cow
O Yes
[] No
Wean to Feeder
Non -Layer
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
-
[] No
Dairy Heifer
NE
Farrow to Wean
[:]Yes
Design
Current
Dry Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Feeder
ID . P,oW
Ca aci
P,a
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
MI Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[S—No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes,
0 No
[—] NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DVM)
O Yes
[] No
0 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
n No
E] NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—] Yes
2q No
[:] NA
NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: - I 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: 7
Spillway?:
❑ Yes
E[ -No
❑ NA
❑ NE
�7—
Designed Freeboard (in):
❑ Yes
O No
❑ NA
❑ NE
Observed Freeboard (in): —ST
❑ Yes
r ---A
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
® No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
PjNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(a 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 t'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ TotaI Phosphorus 0 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): rr' ,-
13. Soil Type(s): �d 01-
14. Do the receiving crops dif]Vr from those designated in the CAWMP?
❑ Yes
E[ -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r ---A
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(, No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[a 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 ER 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 ❑ NI ---
23.
E23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

y Facility Number: date of Ins ection: —11.
S 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (8 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes f,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [KNo
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes MNo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes allo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes allo
permit? (i.e., discharge, freeboard problems, over -application)
3l. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Callo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [] Yes 149No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ,
[:INA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NF
❑ NA ❑ NE
Comments (refer -to- question #) Expiaut an'y YES answers -and/or any additional recommendations°or'any other comments
Use drawings of facility to better egplarn stnahons'(iese additional pages as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'T/fJ3-33DU
Date: -
2/4/2014

i
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q�a4-J Arrival Time: D ! pp Departure Time: CountyRegion:
Farm Name: !Z:yt rOwner Email:
Owner Name:�f/� '/�j---- Phone:
Mailing Address:
Physical Address:
Facility Contact: i-� / /nAa _ Title: Phone:
Onsite Representative: �cr.L.�_ _ Integrator:�-
Certified Operator: $+-tip Certification Number.
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA [] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 No ❑ NA 0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes 0 No 0 NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? (:]Yes ER No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes UjNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Design' Current
�c Design Current
Design Current
Swine
Capacity. Pop.
Wet Poultry
Ga}iactty P p
Cattle Eaparity Pop.
Wean to Finish
La er
ia Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
91po g096VVairy
Heifer
Farrow to Wean
; ' " `
Design Current
D Cow
Farrow to Feeder
D :P,oultr:
. _ -Men.
Ca ac ,�1'ii
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers_
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA [] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 No ❑ NA 0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes 0 No 0 NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? (:]Yes ER No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes UjNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

- Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:/ ,
allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): /� $
Observed Freeboard (in): 3 -7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (&No ❑ NA [] NE
(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
ELNo"
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[Z No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
& No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gl No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land 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 W/ indow ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): �3rf/ar" a /Oyr7/!.j'__
13. Soil Type(s)-
14. Do the receiving crops diffe*om those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
(g No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2, No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Condnaed

Facili Number: - Date of Inspection: (1--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 17M No [] NA ❑ NE
i 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 Qc No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which Cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ['tel No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes �No [:]NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
[:]Yes Lallo
❑ Yes [& No
❑ Yes allo
0 NA ❑ NE
❑ NA ❑ NE
0 N 0 N
Comments (refer to question #1): Explain any YES answers and/or any=additional:recommendstions or anyother46mment .
Use drawings of facility to better explain situations {use additional pages as necessary):

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 491routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: its- Arrival Time:C�-', p Departure Time: County: Region:
Farm Name: W,c� �r. !`3 ;,a-.� F4Wn.1_1 Owner Ernail:
Owner Name:u y -r,-4 cr _ Phone:
Mailing Address:
Physical Address:
Facility Contact: /&Pr�_ Title: Phone:
Onsite Representative:
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream lmoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes rU No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
--tt
Destgn�Ctirrent
Design Current
❑ Yes
Swine
Capacity Pop.
WetPeultry
Capafy Pip:
Cattle Capacity Perp.
0 No
Wean to Finish
❑ NE
La er .`
I
Dairy Cow
[:INA
Wean to Feeder
Non -La er
- "`
Dairy Calf
Dai Heifer
Feeder to Finish 7�
Farrow to Wean
DP,oul
DesignCurrent
Caaci POW
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
I 113cef Stocker
Gilts Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
EL_jOther
Other
Discharees and Stream lmoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes rU No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[-]Yes
53 -No
[:INA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection: -�
f
�g 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
EZ 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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
E] NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N�No
❑ NA
[3 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
� No
F] 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
Callo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
I. 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
EINE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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).- t' /VV car d
13. Soil Type(s):
14. Do the receiving crops dimer from those designated in the CAWMP?
❑ Yes
�g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
[0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
E] NA
❑ NE
the appropriate box.
❑WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes 21 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 U No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes Co No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

` Facility Number:zi_�I Date of Ins ection: 1P --1—t3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D!.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 S No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 6, No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes to No 0 NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to`question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
it
Phone: (Y
Date: %0•— _C
2/412011

Date of Visit: L.LI[a Arrival Time: / Departure Time: !�; �,�County- Region:
Farm Name:y�y ��[�g•-z---%rQtrN'� Owner Email:
Owner Name: r, -I t Phone:
Mailing Address:
Physical Address:
Facility Contact: 14bolr- _ Title: Phone:
Onsite Representative: integrator:
Certified Operator: p 5 4 j��`t° /"� (� �--- Certification Number: p2� yo
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
rrent
Design C+urrent
la
Swine
et Poultry
MIP
op.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
Dai Heifer
o Wean
Design
Eurrent
D Cow
RedeF
o Feeder
D , PoW
Ca aci
Po
Nor -Dairy
o Finish
La ers
Beef Stocker
Non -La er5
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turkey Poults
Other IL
lrlfliAr
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes &No
❑ Yes C. No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IlFacilityNumber: eT :-::= I Date of Inspection: /-
0 No
❑ NA
[] NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[HNo
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
KNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 127
Observed Freeboard (in): ,-D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
®,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
D Yes
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5Z, 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
L&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FR -No E] 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):yyxt�C ! py cfSrr�
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
0 No
❑ NA
[] NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
[HNo
❑ NA
❑ NE
❑ Yes E[ No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
E:] Yes allo ❑NA [D NE
❑ WUP ❑Checklists ❑ Design ❑ MapsF] 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 p Crop Yield ❑ 120 Minute Inspections p Monthiy and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EELNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VjNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - D Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
[-]Yes
EjNo
[_]NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
RNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss 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
allo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboardproblems, over -application)
31 _ Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes O_No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZI No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes I&No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:��3
2�2-
Date: ,ZZ—`)��-
2/4/2011

„� _ _ "._ _ Division afaW,ater�Quality ���'
Facility Number ®- 17 O Division no oil and Water Sr
tioo
Q (?ther Agency
IG
type of Visit: Momopliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: elroutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7o Departure Time: ® County;�Qs a '__ Region: �a
Farm Name: ,' ru G� f � ���-"V piz/'�- Owner Email: '�T�
Owner Name: ilr"y ] r7'e'_'/~,�y, Phone:
Mailing Address:
Physical Address:
Facility Contact: t�re-T Moare— Title: ]� 5��� Phone:
Onsite Representative: Integrator:
Certified Operator: t34S IC/Certification Number: 13�
a
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes K No ❑ NA ❑ NE
❑ Yes
❑ No
Design Current
❑ NE
Design--.Cerrrent
Design Current
❑ NA
Swine
Capacity Pap.
Wet Poultry.
6a ac Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
Dai Cow
Dai Calf
ceder to Finish
p j
_
Dai Heifer
Farrow to Wean
Farrow to Feeder
MR
D Poult .
Design_C.e.nt
Ca aciq
Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
La ers
Non -La ers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
0 NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes JZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ER No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: &2= - Date of Inspection: f a"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: old k3r-w
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[} No
❑ NA
Designed Freeboard (in):
�j{
acres determination?
❑Other:
Observed Freeboard (in): _36- fr
17. Does the facility lack adequate acreage for land application?
❑ 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.)
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[a No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
P�[ No
❑ NA
❑ NE
waste management or closure plan?
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
g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3�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): Z { r -el
13. Soil Type(s): W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[} No
❑ NA
❑ NE
acres determination?
❑Other:
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
[g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
MNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall E] 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
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: - Date of inspection: lI?-
[:]Yes
0 No
4 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
jZ No ❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA for sludge
levels
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
J54 No
List structure(s) and date of first survey indicating non -compliance -
❑ NE
34. Does the facility require a follow-up visit by the same agency?
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Cg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[S 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
lel 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, Check the appropriate boa below.
[:]Yes
0 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
RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
J54 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[B No
❑ NA
❑ NE
lComments (refer to question #): Explain any YES answers and/or any additional recommendatrons air anyiother coininerits.�
Use'drawmies, oflicility to better explain situations {use. additional pages. w: necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7jD y33 33yc,
Date:
2/4/2011

Type of Visit CP'Compliance Inspection a Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit t7 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time:� '� County: Region:
Farm Name: �"'" �a/� Owner Email:
Owner Name: ���5 07— Phone;
Mailing Address:
Physical Address:
Facility Contact: 1/cc /-�Y �� I%—`— I Title: _ Phone No:
Onsite Representative: 02LV Integrator: 0
Certified Operator: gb,,:: ter' err Operator Certificat4 Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
='
= Longitude: a ° =I =
llesign Current
Design Current
Design Current
Sine C•apaeity Population
Wet Ponitry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
[l Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf—J
eeder to Finish ov I
❑NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ NA
❑ Beef Stocker
❑Gilts
RONon-Layers
❑ $eefFeeder
❑ Boars
Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if }res, notify DWQ)
c. What is the estimated volutne 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 09 No ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
[I Yes
[j No
❑ Yes
§jVo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

:i Facility Number: Date of InspectionIT 0
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R 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: FJ �+
Spillway?:
Designed Freeboard (in): e a
Observed Freeboard (in): 31D H q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
to 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
R No ❑ NA
EINE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C4 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C4No ❑ 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
'7 Yes
El No El NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®.No ❑ NA
❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 U% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)/lo5,�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tZ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;K No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
® No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®,No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo ❑ NA
❑ NE
_.
fer to question #): Explain any YES answers and/or any -r y o �n �?"` �
Comments (gre ! :endattons or any other comments
P
ty^
Use draw +n s`of facili to better ex lain situations use.a ld�tional a es `s necessary)
( P g
'
Fw
I_
A n w *k 1 j o kr"'A r -P 15 T x wry ft .
da t-- ,� w
_Q
Reviewer/Inspector Name, w`. 3q
` Phone: �o
Reviewer/Inspector Signature:
Date: _&=;Z
p
Page 2 of 3
12/28104 Continued

j Facility Number: —_6-JD Date of Inspection
Required „Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Cl 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
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ 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
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[KNo
❑ 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
Additional Comnients andlor Drawings.,-
rawings.
Page
Page 3 of 3 1.2/28/04
Page 3 of 3 1.2/28/04

81 s i z - 47 00 9 �, �'� vc.C✓
Type of Visit
ompliance inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
toutine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: O$-J�j Arrival Time: `�� Departure Time: Si.'fS' County: 51.0 Sc" Region: I'2d
Farm Name: - ve reteOwner Email:
Owner Name: Wrt P`+i �-so v Phone:
Mailing Address:
Physical Address:
Facility Contact: 8,0 Vim. Pe--14t�_Jo Title: 69, -)/VC_`— Phone No:
Onsite Representative: i2y 'yo - integrator: M - der ''t"
Certified Operator: F05-5- p��` Y'�N Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E] o E_ -1'
Q Longitude: = ° = I = u
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Gurreot
tattle Capacity Population
❑ Wean to Finish 10
Laver
❑ Dairy Cow
❑ Wean to Feeder 10
Non -Layer I I
❑ Daia Calf
Feeder to Finish 1.71 bb 2
❑ Daia Heifer
❑ Farrow to Wean
Dry Qoultry
❑ DEY Cow
❑ Farrow to Feeder
ers❑
❑ Non -Dairy
❑ Farrow to Finish
❑ NE
8eef Stocker
Gilts
ers
❑ Beef FeederBoars
4r�ENon-La
Pullets
Brood Cowlther
ElNo
Turke s❑Beef
❑ NE
Other
Turke Poults❑
Other
I�umher of Structures: G,
[INA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
U NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
BNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
ElNo
[�,�'!
�lA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
N'o
[INA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:1 Yes
E,
B
❑ NA
❑ NE
other than from a discharge? .
12/18104
Continued

i
Facility Number:
Date of Inspection Z -OS-O
Waste Collection & Treatment
4_ is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: /-'4j r Me-`*) 4!r_ 2 Ln.,
❑ Yes ErNio
❑ Yes No
Structure 5
❑NA [I NE
❑NA [I NE
Structure 6
Spillway?:
Designed Freeboard (in): lf)'2'0,� Zfi�
Observed Freeboard (in): 31 SCf7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) B"
6. Are there structures on-site which are not properly addressed and/or managed [3 Yes L" 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
E
7. Do any of the structures need maintenance or improvement? ❑ Yes , No El NA ❑ NE
E
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ZNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes D o ❑ NA ❑ NE
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) t3�.rn.�,.d.�l Ef�y sw.adl_ Grr:..r (O_S•
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
1 S. is there a lack of properly operating waste application equipment? ❑ Yes
L�7No ❑ NA [:1 NE
E / No ❑ NA ❑ NE
1���,, *N�No ❑ NA [:1 NE
j��,,'�No El NA [11 NE
LI No ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers�and/or any recommendationvok ariy oEher comments. a,
Use drawings of facility to better explain situations. (use additional pages -as eeeessaryj-
r
Reviewer/lnspec#or NamePhone:
910:s�33,33�0
Reviewer/Inspector Signature: R.X;,�, Alex -1.4s1
Date: fz OB"Zdb
12/28104 Continued

Facility Number: 82 -560 Date of Inspection rs did-ci 9
Required Records & Ducuuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes {< No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L'.1 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Rainfall 0 Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ngo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,_ff ,
[:j,"/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Li'l Ngo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
l��.�'� oo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ngo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,1..1,
E o
❑ NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1 `J' 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
''N'o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E5No
❑ 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 NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
I J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/2&/04

LE
ti✓ 3.�s i- 0 8 -a 9 �Z2 ---
Type of Visit E�tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of visit: 1/2-06-08 Arrival Time: 3: OC Departure Time: County: Region:
Farm Name: ��� Pe_� Owner Email:
Owner Name: _ J �n %�'-� V Pe-rSd Phone:
Mailing Address:
Physical Address:
Facility Contact: _ eL VC...p�jrcv-sc--. Title:
Onsite Representative; _ ]3. Pt -41 -`S9 -AJ _
Certified Operator:
Phone No:
Integrator: 52W - Ago -A p, Bam/&?
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 =1
=11
Longitude: ='D 0 , = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page Iof 3
❑ Yes 9 o ❑ NA ❑ NE
❑ Yes
Curreg
rlvllEy
Current Designnt
Swine
Popuisti-. ytoIII.sign
� apaety Populahott Cattle l±apaeity Population
❑ Wean to Finish
_ i;
Cl La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
p �� '''°' " ,;
❑ Dai Heifer
Farrow to Wean
M.
D Poultry �, �
❑ D Cow
❑ Farrow to Feeder
,ry {
[] Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑ Non -La vers
❑ Beef Feeder
❑ Boars
X ❑ Pullets
❑Beef Brood Co
❑ Turke s
-
Other
�.
.cAZ
� � r
a_ +- ❑ Turkey Poults
❑ Other
❑ Other
Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page Iof 3
❑ Yes 9 o ❑ NA ❑ NE
❑ Yes
-ET<
❑ NSA EINE
[3 Yes
❑ No
ENA ❑ NE
2IIIA ❑ NE
❑ Yes
❑ No
❑ Yes
�WA NE
❑ Yes
R o
❑ NA ❑ NE
12/28/04 Continued

Facility Number: fl
Date of ]Inspection __19I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: G1 -on! f_
Spillway'?_
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes B*No ❑ NA ❑ NE
❑ Yes [a'"l�o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes Ej<o ❑ 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 allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 1q0 ❑ 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 81T0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window C1 Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Rj p rA4L �+ /"_ ( _ASl
13. Soil type(s) (� f
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [EKo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
O'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
E3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
EJ -Ko
❑ NA
❑ NE
lS ti&v k rf k c MradF i�
CbMMents Q'JS ee`r�to�qu shon;#) �ExplataF ny S answe andlor�apy recommendaEions or any otter comments.
awmgboftfacility, to,better explatn situations'�(use„Hill ittonal pages as aecessary)q:
lam
A,
7
Reviewer/Inspector Name ��rG +[.Ci =S Phone: 910, 9j?'?, 3 S3
Reviewer/Inspector Signature: 4� Date: %g- -0 b —2-44$
Page 2 of 3 12128/04 Continued

Facility Number: TZ -- Date of Inspection
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes <Jrvo ❑ NA EINE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ []Yes G?go'—' ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
l 5o
❑ NA
❑ NE
❑ Yes
Bigo
❑ NA
❑ NE
❑ Yes
[3V—oo
❑ NA
❑ NE
❑ Yes
0 -Ko—
❑ NA
❑ NE
❑ Yes
G-N—o
❑ NA
❑ NE
❑ Yes
E3 -?4v-- ❑ NA
❑ NE
❑ Yes Blgo—❑ NA ❑ NE
❑ Yes [4 oo ❑ NA ❑ NE
❑ Yes 2wor ❑ NA ❑ NE
❑ Yes Blq-o ❑ NA ❑ NE
❑Yes D -Ko` C] NA El NE
❑ Yes 21 o-- ❑ NA ❑ NE
Additional Commetats and/or Dra R �,*
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey
�
(Type of Visit `®I Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance�
Reason for Visit''outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
c,6
Date of Visit: Arrival Time: L__t= Departure Time: �--F County. Region: N' -'V0_
t'
Farm Name: C asen rr' Owner Email:
Owner Name: V �e `r�-' Phone:
Mailing Address:
Physical Address:
Facility Contact: � Title: Phone No:
.t e� G q 10 3T&S 6'�
� °�X � •_
Onsite Representative: Cqi

Faciljty-Number.sj
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure
ew 2 Structure 3 Structure 4
Identifier: OQ� �y—r
❑ Yes XNo
ElYes 0 No
Structure 5
❑NA F-1 NE
0 N El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeso ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.) ,' VV
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ANo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ 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 l" ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )VNo ❑ NA "❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) � v.rr� 44 i4 . 9�1 464 ' 0A
13. Soil type(s) W
14. Do the receiving crops differ iron those designated in the CAWMP?
❑ Yes
*o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
&�4o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question 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):
Al
Reviewer/]nspector Name Phone: IQ V33
Reviewer/inspector Signature: Date:iP7
12/28/04 Continued

Facility Number - 95 -_�75 Date of Inspection 19/,1Z1011
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [:1 Maps El Other
❑ Yes XNo ❑ NA El NE
❑ Yes -io ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes A No ❑ NA
❑ NE
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain
Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�allo ❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No .MNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo ❑ 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
MNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No qNA
❑ NE
Other /Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes ,'"C, No [:INA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PibNo
❑ 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
kl.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 . 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
ANo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J)�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
u
12/28/04

Type of Visit Corn ante Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routlne O Complaint O Fallow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit. -] Q Arrival Time: r Departure Time: County: San Region: T
Farm Name: [ V Sdri 'r-(3Li' 11ti Owner Email:
Owner Name: \1� ��7��-_ �^ Phone:
Mailing Address:
Physical Address:
}�}
Facility Contact: C:Ni ear [ M� Title�� Ck SOQC,. = Phone No:
Onsite Representative.L Y ZKJ 1 1 10W V_ 1 U2_1 UL f` tf-�O "--' integrator: V LCM SSL
Certified Operator:�5� ��-Svc Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Q o ❑ ' ❑ « Longitude: ❑ o ❑ ' ❑ u
❑ Boars
Discharges & Stream
Imparts
. Is any discharge observed from any part of the operation'? ❑Yes C.1 No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field ❑ father
a. Was the conveyance man-made? ❑Yes ❑ No Ej'�A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ Na S -'5A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? �,/
d. Does discharge bypass the waste management system? (if yes, notify DWQ) E] Yes E] No �] NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'! El Yes ❑44 , ❑ 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 1 of 3 12/2
Design Current Design Current
Design Current
Swine
Capacity Population VVC!j ultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La cr
❑ Non -Layer
❑Dai Cow
❑Dai Calf
❑ Wean to Feeder
Feeder to Finish 12LQ2❑
Dairy Heifer
❑ Farrow to Wean
Po It
El Da Cow
Farrow to Feeder
El
„_
❑ Layers
El Non -Dairy
Farrow to Finish
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Pullets
❑ Beef Brood Cove
OthEl
er
Turkeys
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
❑ Boars
Discharges & Stream
Imparts
. Is any discharge observed from any part of the operation'? ❑Yes C.1 No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field ❑ father
a. Was the conveyance man-made? ❑Yes ❑ No Ej'�A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ Na S -'5A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? �,/
d. Does discharge bypass the waste management system? (if yes, notify DWQ) E] Yes E] No �] NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'! El Yes ❑44 , ❑ 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 1 of 3 12/2
8104
Continued

Facility Number: a.
Waste Collection & Treatment
Date of Inspection
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes li�<D ,❑,, NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [I No E2 A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �f
Spillway?:
Designed Freeboard (in): 6li Iq if
Observed Freeboard (in): 5=1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L'Ko ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ❑4o [INA ❑ 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 3-i o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) K��
4. Does any part of the waste management system other than the waste structures require ❑ Yes U ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lfd' ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below_ ❑ Yes 0 -go ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s) C. i -n _rn
14. Do the receiving crops difl"er from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[' lqo ❑ NA ❑ NE
[[�No ❑ NA ❑ NE
ff, o❑ NA [_1 NE
l_'7No El NA El NE
❑No [:1 NA [j NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or anyther cam�ents
.Use drawings of facility to better explain situations. (use additional pages as:Qecessary): Q�';ti f .,. 9
l C� l isz v t 4
J' ? c�C
Reviewer/Inspector Name � (j� p_j Nt ; 01 1 Phone: Q S
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

4 Facility Number: M51 Date of Inspection 1 %
Re aired Records & Documents ,,__,//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 0"1 Imo ❑ NA ❑ NE
the appropriate box_ ❑ WUP [] Checklists ❑ Designp
❑ Mas El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
00,1�o
[:1NAElNE
[9 -NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
❑ No
ENA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
9NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ No
BNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R -Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[9 -NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2<o❑
NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
L!d'1vo
❑ 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
BNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
��
Uj<o
❑ 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
M/NNo
ElNA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R/leo
❑ NA
❑ NE
Additional.Comments and/or Drawings:
AL
H,
Page 3 of 3 12/28/04

f;
Facility No' �" -r Time In _ 1. Time Out Date
Farm Name Pf- V -I - Integrator
Owner Site Rep
Operator
Back-up
COC +�
C47
Circle: err or
_ No. _
— No. -
NPDES
Design Current Desi n Current
Wean - Feed Farrow - Feed
W - ish Farrow - Finish
- Gilts 1 Boars
Farrow - Wean Others
FREEBOARD: Design Observed
Sludge Survey L ' Calibration GPM 1
Crop Yield l___ Waste Transfers
Rain Gauge V Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall 1 -in Inspections
Spray/Freeboard Drop Q W` 17C�
Weather Codes 120 min Inspections
Waste Analysis: r i ts
Date Nitrogen (N)
/
Date
•Z--
Nitrogen (N)
Pull/Field Soil Crop Pan Window

✓z�Z�t�,paS
-- � Division of Water Quali#y _`�
IEaciI N_ umber &2 �$ D� O Division of Sail and Water Conservation
0 Other Agency
Type of Visit * Compliance Inspection: O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:: pQrDeparture Time: County: Region:
Farm Name: __.vrci r''� rA-f'w_L. Owner Email:
Owner Name: . �.re�. T Phone: ?1„ D
Mailing Address: i 0 S t1J ctk yr-
Physical Address:
Facility Contact: geAVV- �cJ�^ Title:Phone No:
Onsite Representative: E�{ %JCL ReAe-CYasrsoL- NjjWBntegrator:
Certified Operator:—i!=st! t.I SS Operator Certification Number: -Z2 0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 =11
Longitude. =0=6
°=6 0
di
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
�] Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urk-ey Poults
❑ Other I f__::::d
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Po
El Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cod I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of'Structures: �I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
?. 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 W No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-INA
EINE
El Yes
[--]No
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/18104 Continued

,facility Number: Z — 5 o]
Date of Inspection Z 21 O
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes A No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: 9"
Spillway?: No Nb
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Eq 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 KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ yes q No [-INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes n No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN >l 0% 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) &rVVt1j�� � S vvt" - c�ra:' r. O SQ --
13. Soil type(s) A r`etAM%.
14. Do the receiving crops differ from those designated in the CA W M P? ❑ Yes 0 No ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes [&No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[] Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[RNo
❑ NA
❑ NE
IReviewer/Inspector Name Picone: ?f0 - "y $(Q/- Is -ft I
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Fatcility Number: BZ -5_8 Date of Inspection
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP✓ ❑ Checklist ;KDesign- ❑ Map3/❑Other
❑ Yes KNo [DNA ❑ NE
0 -Yes ❑ No [INA ❑ NE
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard] Waste Analysis/E] Soil Analysil,"11 Waste Transferal ❑ Annual Certification
❑ Rainfall ❑ Stocking' ❑ Crop Yiel*'** ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspection3"❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge'?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes. contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32- Did ReviewerAnspector fail to discuss reviewlinspecLion with an tin -site representative?
33- Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
EINE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
C.No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
§!-No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NF
❑ Yes
9j No
❑ NA
❑ NE
❑ Yes 9C No ❑ NA ❑ NE
Additional Comments and/or Drawings:
-
b"��
F
g
I1��8`oY
o. rZ
z_o
912�o't
6� 3S
0 42
[.7
Y/I(eAl
21
-Z,/' 'f to'(
0. zz
3•�
"¢a cA) aa_,-+` 5; rum FeLr r � 2,002—
00Z .
Trdv.ti-s'4•er� � Wa S� -��=�-..vim '�'�-¢_�3
�4�iL �G�c-r a,cr..�. �D
�-�,��"`
j
t
12128104

Facility Number mate or visit: l� �� Time:
Q QD
Q NotOperational Q Below Threshold
Mermitted .(Certified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: -. .
Farm Name: ... - bac l tom....._. County: .... Sa"^ �.___—__—
Owner /�Name:.... f a!?..........».»�/��_)_ . Phone No: _.. it o S"qa 76;-d�
Mailing Address:.... _/! o.5' Mr.
_ i?til t+�d ..i.�� �l�'» !�d . � �: " 1'e�►».� �! � �_� --____ _ � D �a g—.
Facility Contact: .._�?t'dk!a......
/ !�ar!..................... Title: ---•---- ........_........Phone No:
Onsite Representative:..-. ! �<. Aka<lf ....._..._.. � ..... Integrator: » , Ti��.►:K.r. ,R ..__ _ .... _ .. _
Certified Operator:, ✓_ £� .. _ �G'??S�'� �. Operator Certification Number:��I
Location of Farm:
Gafw-ine ❑ poultry ❑ Cattle ❑ Horse Latitude ' 4 44 Longitude • 4 44
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?Yes E3rN
❑ o
Discharge: originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [a'fvo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3
Identifier: ........». I.1._ ............... .......... ...................._....._.----..........................
Freeboard (inches): 35 llz& A 74 `r"
Structure 4
.11
❑ Yes Bwo
Structure S Structure 6
1.2/12103 Continued

• IFacUity Number: &a -- Lo
Date of Inspection • o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
4. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I . is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
//
12. Crop type C.G�t5'{u(_ �tr...,JA) tte j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
❑ Copper and/or Zinc
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [9,90
❑ Yes Q'�To
❑ Yes [moo
❑ Yes a -No
❑ Yes 2 -No
❑ Yes [3'90
❑ Yes [}Ko
❑ Yes [flo
❑ Yes [�10
❑ Yes E3"No
❑ Yes [f10
❑ Yes O'go
❑ Yes E911c,
❑ Yes [1No
❑ Yes Bfgo
❑ Yes [1Io
❑ Yes [,'N o
Comets {refer �o het oa) Expfatn`any YFS answers anal, any recommeadatl ns or ate► otner contmeats. F
.'_ .+' --` -...c.^..x,;..:-r
=[Fsc drnwuns of Ese�y to bather etrpls a sitnaons. (rtse addtttcnal pages as neotssatY) Fteld Copy ❑ Final Notes }
�-_?r.
Us a.J ero{t fo' k e}
�
/kw 44 ft vt
kfit�Fµ�n; b►•:1 �i Sit �� �G T,h��� .rit�,q U Q S - !��/�'u
V i•rn �l Q 9 ✓L�'"`i �F-p�w � s� 7 �i%� ii(C i/iG i� ._. a%�j ,
Reviewer/Inspector Name �•_4 v_ — =y A�. , v
are:. ? h y
Reviewer/Inspector Signature:Date. p
12112103 1/ Continued

Facility Number: 9.2 Date of Inspection /• o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit ar 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 Farm ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes a o
❑ Yes ZNo
[:]Yes [ff'No
❑ Yes dNo
❑ Yes [ErNo
❑ Yes E!rNo
❑ Yes No
• Yes �No
❑ Yes Gj'No
❑ Yes Q No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 No violations or deficiencies were noted during tliis visit You will receive no further correspondence about this visit.
ddittonal CommentS,andfor Drawtngs _.~24. _
1f p ,1 ", Le .j.e yt ,.lL� 1y 14, 1
cro
L*1"+° lr 4cr-i o,�Ietej `% /9' !d 'r
Ll
12/12103

If`K �..,Ts�':�`r �,-.nam.- .r. '.:�z�;�..r-'. »*:�-..� _..r., ._-.,..--��=-. _ .... �__,.. _ «.. -.._ � . .. =,. .=.:_i::. �_-., :... ..�•_ - - -�1
(Type of Visit ID Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 'O3 Time:
Facilit+� Number
--rO Not 011erational 0 Below Threshold
Permitted 10 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm !\ame:✓t' i'7 r County: �ySQi�1DSD�'i
Owner -Name: �e ba �f 7�/� �ti Phone No: `71� -s gad 76
)tailing Address: _� 70a 0, 17-r 6 e`i(7' CftrJ�� � - //t/aH � ���.2y
Facility Contact: /n�� II I_ Title: Phone No:
Onsite Representative: ddya-_ Q �e7'erson Integrator: MO vot 5 Ar
Certified Operator: s 1'2kup', Operator Certification Number: 7.77
Location of Farm:
MSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & " Longitude ' �• ��
Design Current
Design Current Design Current
Swine Ca achy Population
Poullry
Ca achy Po ulation Cattle Ca acw Population
❑ Wean to Feeder❑Laver
❑ Dairy
2Feeder to Finish 1914901 ;1
10 Non -Laver
L
❑ Non -Dain
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ( ;41 _ 1 ALJ Subsurface Drains Present E{U Lagoon Area II__l Spray Field Area
Holding Ponds / Solid Traps 0
[7—IN—To Li uid Waste Management Svsiem
Discharges g Stream impact;
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsen-ed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharse is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
tructttre 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier Gl ill t Q
Freeboard (inches): 37 50 .1
05/03/01
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes Pallo
Structure 6
Continued

Facility- Number: qrj—_Jo Date of Inspection
Does the receiving crop need improvement?
❑ Yes
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
❑ Yes
ER No
R1 No
seepage, etc.)
6.
Are there structures on-site which are not properly addressed and/or managed through a waste management or
0 Yes
®No
18.
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
❑ Yes
rL--71 No
immediate public health or environmental threat, notify DWQ)
❑ Yes
§a No
7.
Do any of the structures need maintenance/improvement?
❑ Yes
®No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[0 No
9.
Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
❑ Yes
No
22.
elevation markings?
❑ Yes
®No
M ante ADMieatiOn
10. Are there any buffers that need maintenanceArnprovement? ❑ Yes ® No
11- Is there evidenceof over application? ElExcessive Ponding E]PAN ❑ Hydraulic Overload ❑ Yes ® No
12- Crop type (/na i r Ae _r&&�a -
13. Do the receiving crops differ with those designated in the Certified Anima) Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This faciliry is pended for a wettable acre determination? ❑ Yes 91 No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
Yes
R1 No
Required Records & Documents
17.
Pail to have Certificate of Coverage & General Permit or other Permit readily available?
0 Yes
®No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ R'UP. checklists, design_ maps. etc.)
❑ Yes
§a No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facilizv fail to have. a actively certified operator in charge-
❑ Yes
No
22.
Tail to notify regional D« -'Q of emergency situations as required by General Permit?
❑ Yes
®No
(ie' discharge. freeboard problems. over application)
23.
Did Reviewer1rispector fail to discuss reviewAnspection with on-site representative?
❑ Yes
®No
24_
Does facility require a follow --up -6sit by same agency?
❑ Yes
21 No
25. were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
1� No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Coinitients trefer to aestivu E lain a'a YES aaswer9 andlor adr+ecammeadahoas ar au}* other.cotnm_.
Use drawntr s of facsliity to better explain situations. (use additionai_pages as aeoessary) ❑Field Copy- C3 Final Notes
Reviewer/inspector Name _
Reviewerfluspector Signature:
Date:
05/03/01 Conrurued