820602_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qua

t
Type of Visit: <Y Com ance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Rout"tne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: D County: / Region:t7
Farm Name: J� tom?/ fyf-rQ7�`f�i-�rJ a�Gi� Owner Email: �—
Owner Name: ✓UJy y i �� 7`¢�i g Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ! j�
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[] Yes
Layer
❑ NA
❑ NE
Dai Cow
Wean to Feeder
L`J 'No
Non -La er
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dai Calf
Feeder to Finish
❑ NA
❑ NE
of the State other than from a discharge?
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D Poui _
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
BoarsPullets
Beef Brood Cow
Turkeys
Other
t
TurkeyPouits
Qther
Other
Discharizes and Stream lm acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
Q Yes []-No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
C] Yes
L`J 'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
B - Ko'
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412015 Continued

Facility Number: JDate of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
hlo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
L244o
D 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
[:JI�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[i]'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /` f res'' er % rL x"/ "' d41-11-1 G�
13. Soil Type(s): d ,c
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E]-�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes f'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E:] -<o ❑ NA ❑ NE
❑ Yes [3 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 E]_'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3"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 [Z"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
D NA ❑ NE
Page 2 of 3 2/412015 Condnued

lRadyty Number: - L -O9— Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? • ❑ Yes Q No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D<O
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 (PLAN') 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, cheek 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 ReviewerAnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E2r&o ❑ NA ❑ NE
❑ Yes D] &o ❑ NA ❑ NE
[D Yes E] No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes []] No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes
[EN.
❑ NA
❑ NE
[] Yes
[D'No
❑ NA
❑ NE
❑ Yes
0--N'o
❑ NA
❑ NE
Comments (refer to guestio& Exptatn any YES answers and/or any additional recommendations or any other comments.
Use drawings offactlrty to iie[ter egpl_airhsit i ,tiuzis."(use additional as necessary): '. A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g'IU 3y3--_0 1s/
Date: //��g1��Jl1i✓
2/4/2015

i'vision of Water Resources
Facility Number - Q Division of Soil and Water Conservation
O Other Agency
Veasoon'for
pe Visit: Compli ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q;r Departure Time: County:.. Region:
Farm Name: Qd^,Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back -ftp Operator:
Title: KYr`' Phone:
Integrator:
Certification Number:
Cert>if'iestion Number:
Location of Farm: Latitude: Longitude:
Discharses and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes [n.No
❑ Yes M_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
/
Design
Current
Dai Heifer
D Cow
Farrow to Wean
Farrow to Feeder
D , P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I 113eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharses and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes [n.No
❑ Yes M_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: D —i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fo No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® 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
M. -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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
E. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� No
C] NA
[:]NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
-]Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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 d
12. Crop Type(s): ;i'"9d %cf
13. Soil Type(s): �.lEi � C-;- �
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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 Yes 5a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M 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 M 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 [g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 64 -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number:- Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED -NO
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
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 E?�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes S No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW?"?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ NA ONE
❑NA []NE
❑NA ❑NE
❑ NA [] NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [�5 No ❑ NA ❑ NE
[:]Yes � No [:]NA ❑ NE
❑ Yes RNo
❑ Yes M No
[3 Yes ERI -No
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: t`
Date: y7t;:L290/
21412015

Type of Visit: p -Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine O Complaint 0 Follow-up Q Referral 0 Emergency 0 Other O Denied Access
Date of Visit: I—llo I Arrival Time: ! t7 r? Departure Time: na County: 4 of Region:
Farm Name: R 11, t4L— - f- )?"J4 /:i;"e"_Awner Email:
Owner Name: t y 1 f' ; g . Phone:
Mailing Address:
Physical Address:
Facility Contact: 7O.2 V Title: A�oh Phone:
Onsite Representative: „j��� Integrator:
Certified Operator: /�C Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_
;Design Current
❑ NA
Design
Current
Design Current
❑NA
`Capacity Pop.
Wet Povitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
_3311
Daig Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , l;oultr
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Co-
owTurke
Turkeys
s
Qther
Turkey Poults
Other
Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [51No [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes n No
❑ Yes 2�-No
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

Facill Number: g2= j�7Date of Inspection:
❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
Waste Collection & Treatment
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes allo
4 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
Gni¢
Identifier:
13. Soil Types}: % C G'c
21. Does record keeping need improvement? If yes, check the appropriate box below.
Spillway?:
❑ Yes jg No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Designed Freeboard (in): Z9 -
_ -Observed
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes � No
ObservedFreeboard (in): ,>?
❑ NE
acres determination?
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
MNo
❑ 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
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes O No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.)
❑ NA
❑ NE
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
JQ
❑ Yes ® No
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application
Outside of/Approved/Area
the appropriate box.
12. Crop Type(s):'"%7'Z( /Dyt'�`'Y� �d n �1.*��r-���,_6_��-
5 / ✓tet f
Gni¢
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
13. Soil Types}: % C G'c
21. Does record keeping need improvement? If yes, check the appropriate box below.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes jg No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JR No
❑ NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes � No
❑ NA
❑ NE
acres determination?
❑ NA
❑ NE
Page 2 of 3
17. Does the facility lack adequate acreage for land application?
❑ Yes W No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes O No
❑ NA
❑ NE
Reuuired 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
JQ
❑ Yes ® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes _Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [3 Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes � No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes _Fk] No
❑ NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NF
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �4No ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jD 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 M No [] NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes E. No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �&No
❑ Yes allo
❑ Yes C No
0 NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Comments (refer.to question #) Eaplam any-YES*answer§sand/or-any addifioaalFrecommendafions or:any otliercommentx.'
Use drawings.of facility. to better explain si.tuA ons _(nse�adtftttonaI pages as necessary)
Reviewer/Inspector Name: 5'�l'r-`-�- ( v,--
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g/u " s3-3nrl�
Date: -- %L
214120IS

• Di"vision of Water Resources
Facility Number t--+ -LL�� a Division of Soil and Water Coaservatian
0. Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: {Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:�� G / Arrival Time: ' p Departure Time: '3 t7 County
%`
Farm Name: e %y� — fes. ��S � is ' (�?wner Email:
Owner Name: jZ2,1 Phone:
Mailing Address:
Physical Address:
Facility Contact:
1,YIA7wi3 Title: Phone:
Onsite Representative: Integrator: �r'y� �_
Certified Operator: U ``mat o Certification Number: / 7r J
Region: D
Bach -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
DesigQ Gurreat
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
❑ No
❑ NA
Dairy Cow
Wean to Feeder
Layer
❑ No
❑ NA
Dairy Calf
Feeder to Finish S2,11Dairy
Heifer
Farrow to Wean
❑ Yes
Design
Current
Dry Cow
Farrow to Feeder
I) . P.,oultr
Ca act_
P,o
Non -Dairy
Farrow to Finish
Layers
[Z No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Z No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/411014 Continued

[Facility Number: - D Date of Inspection: — 6�— s -
Waste Collection & Treatment
+ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes B No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to`the�integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [Z No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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 FQ No
❑ NA
❑ NE
& Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
9. Does any part of the waste management system other than the waste structures require ❑ Yes C.No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
&No
Waste Application
❑ NE
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F5r-No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
M -No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
214/2011 Continued
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
to -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
E,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ 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
to -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
MNo
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M -No
❑ NA ❑ NE
Page 2 of 3
214/2011 Continued

Facili Number: - d Date of Inspection: & —1-4--
24.
3"24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PqNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2 -No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor 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?
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 [Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
to No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
®,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
C3 -No
[] NA
❑ NE
Comments refer to question #): Explain any YES answers and/or any additional recommendations or any -'other comments"`= 4
Use drawings of facility to better explain situations (use additional pages as necessary). '
Reviewer/Inspector Name: .S�yy -z-- Phone: j% 3
Reviewer/Inspector Signature: Date: Qb/�
Page 3 of 3 2/4/2011

Type of Visit: 90Tompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (?�Koutine 0 Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: /:Op Departure Time: County: Region:
Region: �7
Farm Name: k u n -t y, /Z�� /tA� jr�y..� Owner Email:
Owner Name: / T n te %%'f � j�� Phone:
Mailing Address:
Physical Address:
Facility Contact: 22i�ry wa �:, s Title: jgWn r.P1
f
Integrator: / r"
.01
Certification Number: /'70--1v3
Onsite Representative:
Certified Operator:d v2 pc/� j%%u is _
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude. -
Design Current
[:]Yes
Design
Current
Design Correa
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Gapaeity Pop,
Wean to Finish
La er
❑ No
❑ NA
Da" Cow
We to Feeder
Non -La er
C, No
❑ NA
Da" Calf
Feeder to Finish
[:]Yes
E�,No
[INA
Da" Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
i urke s
Other
7 urkey 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?
❑ Yes D§,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2" Is there evidence of a past discharge from any part of the operation?
❑ Yes
C, No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
E�,No
[INA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: - d Date of inspection: Ig —,77 3/j4
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
❑ Yes
(aNo
Designed Freeboard (in): ` f^
❑ NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):
Pq No
❑ NA
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?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
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 CR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/WindDrift 0 Application Outside of Approved Area
ut
12. Crop Type(s): ge-e a latY� LOM / LUit���SyVy,.j s,� ! 5�,/U11je
13. Soil Type(s): Z013 /eX d—./Id 14 Z 141 A '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CoNo ❑ NA ONE
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
(aNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pq 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
Ea No
0 NA
❑ NE
the appropriate box.
❑WUP El Checklists []Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CR 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 to No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®. No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Faci:l' Number: - Date of Inspection: / — 3 f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [INo ❑ 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�f first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of.emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
[2 No
❑ NA
0 NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes KL No ❑ NA ❑ NE
[:]Yes lEg,No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes gNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which Cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J&No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
O NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any;other comments
Use drawings of facility to better expiiun si6ations (use additional pages:..-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �'/Ia—e33
Date: �4-2 a- p��/�
214!2014

Type of Visit: ompliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint d Follow-up 0 Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ; j -D I Departure Time: 1.�� County: Region: {9_0{D
Farm Nam Owner Owner Email:
Owner Name: n y /?7� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �-
p � y �—�� %%% Integrator:
Certified Operator: olw�ilj 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?
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
[Z No
❑ NA
❑ NE
[—]Yes
Design Current
❑ NA
Design
Current
Design Current
Swine Capacity Pop.
R'et Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oultr
Ga 'aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
[Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Ocher
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[Z No
❑ NA
❑ NE
[—]Yes
5q_No
❑ NA
[] NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
[—]Yes
5q_No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 2/412011 Continued

Facility Number: - (. 0a— I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FStNo ❑ 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: f
Spillway?:
Designed Freeboard (in): _ %9–
Observed Freeboard (in): �y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;�SNo ❑ 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
LK No
❑ NA
❑ NE
waste management or closure plan?
No
❑ NA ❑ NE
the appropriate box.
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
J4 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)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� No
❑ NA [:]NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
2/4/2011 Continued
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
X[No
❑ NA
❑ NE
❑ Excessive Ponding Q 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 %Xko
12. Crap Type(s): ,-1yvcda r–ra /( YA1 rs-.� / L(JJltea. /Gar
13. Soil Type(s):� //r/¢ /¢ N 11'Va OF
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ WE
[:]Yes ja No [DNA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes
MNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis D 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
JZNo
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: - O Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CK 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 JR No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
Yes fo No ❑ NA ❑ NE
❑ Yes [SnNo - [] NA ❑ NE
❑ Yes No
❑ Yes ,® No
❑ Yes �0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional reeommendations�or:any other comments
Use drawines of facility to better explain situations (use additional oaees as necessary). r x
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: /� I
2/4/2011

r
o Division of Water Quality
Facility Number ®- l Y� OO Division of soil and Water Conservation
S Ca llthnr Soanry
Type of Visit: Q'Compiiance inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ! / 5' Departure Time: County: 15gZ 2_,f4;- Region:
Farm Name: &I &fj�� Off ' Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: "Gy,�
Title: &,re'
ti
Integrator: L/'?4Z
Phone:
Certified Operator: Certification Number:L
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Diseharees 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 gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes MNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes PI.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/1011 Continued
Desi Current
x„� r
Design
CurrentDesign
Current
Swine
Capacity Pap.
gWet Aoultry
Capacity
Pop.
Cattle MICLapacity Pop.
*
-
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean-
Design
Current
D Cow
Farrow to Feeder
D P�oWtr
Ga aci
PN ,
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turke s
Other
Turkey Poults
Other Other
Diseharees 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 gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes MNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes PI.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/1011 Continued

F'acilit Number: 77 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes O_No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
MNo
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
[E�No
❑ NA
Observed Freeboard (in): _ 3 0
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �"o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
O'No
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes allo
❑ NA
❑ NE
waste management or closure plan?
O -No
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures treed maintenance or improvement? [:] Yes 14 No
❑ 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 Jallo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
❑ Waste Transfers
❑ Weather
10. Are there any required buffers, setbacks, or compliance alternatives that need F] Yes ERIN
❑ NA
❑ NE
maintenance or improvement?
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U4.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
F;LNo
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ NE
❑ Outside of Acceptable Crop ❑ Evidence oof/Wind Drift Application of Approved Area
/Window /Outside
- !❑�
12, Crop Type(s): r�� M Ii. 4'ndj
2/4/2011 Continued
13. Soil Type(s):_3LZ f� T i c _
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
MNo
E]NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O'No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
O -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
jg_No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall Q 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
KNo
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F;LNo
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: - z? Date of Inspection:�-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
i
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [&No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EkNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
❑ Yes R1 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
[:]Yes [&No ❑ NA ❑ NE
[:]Yes yallo ❑ NA ❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑Yes
[j�No
❑NA
❑NE
❑ Yes
2No
❑ NA
❑ NE
Comments (refer to question #t): Explain .any YES answers'and/or any -additional recommendations or.:any ©tEter4:commen6
Use drawings of facillty'..to better explain situations (use additional pages as necessary). =
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7—/-a/._
2/412011

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (BrVoutine Q Complaint Q Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ' t7 Departure Time: Count__ Region:
Farm Name; ;f caner Email:
Owner Name; Phone:
Mailing Address:
Physical Address:
Facility Contact: -7—&-uq /y%� Title: {�n,�y/ Phone:
Onsite Representative: y�J ° Integrator.
Certified Operator: Certification Number: i� 3
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)?
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 N No ❑ NA [] NE
❑ Yes [❑ No
❑ Yes [❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 54,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.-W,et'Poaltay
Capacity
P €gip.
C■attle Capacity Pop.
Wcan to Finish
La er
Dairy Cow
Wean to Feeder
Non-LaVCT
Dairy Calf
ceder to Finish-
D (?pultr..
Design
Ca aer
-`
"
Current
PP.s
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N No ❑ NA [] NE
❑ Yes [❑ No
❑ Yes [❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 54,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - I Date of Inspection:
❑ Yes
JgZNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
?�( No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KNo
❑ 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
E] 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
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V1 No
❑ NA
E] 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
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ 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):
A
j
13. Soil Type(s): _ �p� ICS
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
ES�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EQNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JgZNo
❑ 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
r� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
MNo
❑ 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 XLNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes & No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®..No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: (�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [§„ No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA 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 fg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0_No [DNA ❑ 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, aver -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 54No ❑ NA ❑ NE
❑ Yes ,SCI No ❑ NA ❑ NE
❑ Yes Q_No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
- C] NE
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to q estion #):-Explain: any YES.answers and/or any additional.recommendations or any other comments -
Use'drawings of facility to°better eiplain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 6 IG 420//
2/4/2011

Type of Visit (116a_rnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: = Couuty: �'J Region::T ;
Farm Name: T 1111— Owner Email:
Owner Name: r ! 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: - Title: Phone No:
Onsite Representative: Integrator: �
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =1 F-1"
Longitude: a ° = =
Destgn
C•ut rent Design Current
Design Current
Swine Capacity
opuiatian Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
ILI Layer 1
Dairy Cow
❑ Wean to Feeder
110 Non -Layer
1
Dairy Calf
❑ No
Feeder to Finish
D
[]NA
❑ Dairy Heifer
❑ Yes
❑ Farrow to Wean
❑ NA
dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
ElGilts
Non -Layers
❑ pullets
❑❑Beef
Turkeys
❑ Beef Feeder
Brood Cow
❑ Boars
Other
❑ Turkey Poults
JO Other
Number of Structures:
❑ Uther
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does 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 6�[No ❑ NA ❑ NF
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
[]NA
❑NE
❑ Yes
CgNo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Reviewer/Inspector Name !/� L e Phone: ZIP y �
Reviewer/Inspector Signature: Date: /p
Page 2 of 3 12/28/04 Continued
Facility Number: — 6 Date of Inspection
Waste Collection & Treatment
' 4. is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
J9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®.No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RLNo
❑ 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
[S No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffeis, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
[ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Driftt� ❑ Application OutsidyAe- of Area
%Window
12. Crop type(s)
13. Soil type(s) �� / e 4 _ _-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C9 -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA
❑ NE
Reviewer/Inspector Name !/� L e Phone: ZIP y �
Reviewer/Inspector Signature: Date: /p
Page 2 of 3 12/28/04 Continued

Facility Number: A2—(gyp Date of Inspection 1 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CONo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑ Uther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Cj�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
tO No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[21 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2,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
;R No
❑ NA
❑ NE
33.
Dosis facility require a follow-up visit by same agency?
❑ yes
�gNo
❑ NA
❑ NE
Additional Comments'landloir; Dr�wiags; `.ry '
T1
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
eoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ' 0 1 Departure Time: %Q , County: Region: „Jf E-0
.4f
Farre Name:i1l�l�rai on_ FryOwner Entail:
Owner Name: T-0• -, y /i%,r Phone:
Mailing Address:
Physical Address:
Facility Contact: X Qlazz" IYiu 2:M Title: Phone No:
Onsite Representative: Integrator: P_rz^ 2i�-
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = =a Longitude: 1:10=, =
Desiga
Swine Capari
❑ Wean to Finish I
❑ Wean to Feeder
Curren# Design Current
Population Wet ou Capacity Popaiatioq
I ❑ Layer I
tO Non -La er I 1
Design Curren
Cattle Capacity a alatiaa
Dairy Cow
❑ Daify Calf
Feeder to Finish
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
0 Non -Dairy
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑' Gilts
❑ Yes
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑Turke s
t3tber
❑Turke Points
❑ Yes
❑ Other
I ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RN`o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[INA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[]Yes
51 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[9 No
❑ NA
❑ NE
other than from a discharge?
11/28104
Continued

+ Facility Number:Date of Inspection LL?_=L.CJr
Write 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 Stniciure 2 Structur4 3 Structure 4
❑ Yes JX No ❑ NA [' NE
❑ Yes ❑ No ❑ NA ❑ NE
tiEructure S Structure 6
lderttifitr:
Spillway?:
Desi fined Freeboard (in): j 9
ReviewerllnspectorNome7� 6 —µ �, Phone:
Observed F'recboard (in): _ Lq7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[FNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
19No ❑ NA ❑ NE
through a waste management or closure plan?
❑ No
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
PA No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
FX -No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
CA No ❑ NA ❑ NE
maintenance or improvement?
❑ NA
Waste application
17. Does the facility lack adequate acreage for land application?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C& No ❑ NA ❑ NE
maintenance/improvement?
❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CA No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) �or+n,e,,�eL��IJ«; �r�llCLlrrf�-�ynr.x� ��r< �%bt�ii
Tlz
ReviewerllnspectorNome7� 6 —µ �, Phone:
Reviewer/inspector Signature: Date:
13. Soil type(s) n �'a ! 1 Wt
14. Do the receiving crops differ from those designated in the CA WNW?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
El Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question 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):
ReviewerllnspectorNome7� 6 —µ �, Phone:
Reviewer/inspector Signature: Date:
12IZ8104 G'onnnued

' Facility Number: 37 — Date of Inspection
Required Records & Ductiments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ 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 T'ransfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CKNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
[] NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
El Yes
VQ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�%No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Comments and/or
12/28/04

Type of Visitompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O complaint 0 Follow up O Referral O Emergency O Other 0 Denied Access
Date of Visit:&� Arrival Time: 31 Departure Time: County Region:
Farm Name; _(.c h r__ —'. Owner Email:
Owner Name: _ / "y V, _ �%%!1 '� i Phone:
Mailing Address:
Physical Address:
Facility Contact: -S Title:
Onsite Representative:
Certified Operator: :9� _
Sack -up Operator:
Phone No:
Integrator -
Operator Certification Number -
Back -up Certification Number;
Location of Farm: latitude: ❑ o =i [=14 Longitude: =° 01 =46
Design Currents Design Currerit Desegn Current
.`
Swine Capacity Population Wet Poultn•Capaty Populahon;4=cattle Capacity PapWation
EWean to Finish ❑ La er 0.❑ Dai Cow
Wean to Feeder ❑ Non -Layer ❑ Dai Calf
Feeder to Finish ;. .= - -_ Dai He
��� ❑
❑ Farrow to Wean Potiiti-y '� ❑ © Caw
❑ ❑N
Farrow to Feeder "� `�`" '` ary
❑ Layers . on -Dai
❑ Farrow to Finish _ ❑ Beef Stocker
PE113oars.
Gilts Non -La ers ❑Beef Feeder
❑ Pullets "'`
M1rood Ca
ElTurkeys
El Beef S
Other TurkeyPoults
El Other _ ❑OtherNumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KIo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes KNo ❑ NA ❑ NE
[I Yes [:1 No [3 NA ❑NE
Structure 5 Structure 6
Identifier:
Spillway?:
Reviewer/Inspector Name
Designed Freeboard (in): 1
Reviewer/Inspector Signature:
Date:
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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
J&No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ZNo
[INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2kNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CKNo
❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) �.l 1 U✓!" Yr_ a>w r �t�c!`/�i7r�
J.
13. Soil type(s) :6")
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
[3.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
[2 No
❑ NA ❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA ❑ NE
x ,�e�'�fer ta�giiestiort#) Eapla�n�an�yY+ESIan�wers�andlor aoy recammendaho..ns or aQy other comments,
+Use`'�,'drawinf facility to better explain situafions,�{use dtlttional pageslas necessary.), ,.
Reviewer/Inspector Name
Phone: IL`- 33-3300
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

i Facility Number: t7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �gNo ❑ NA ❑ NE
the appropriate box. Cl \VUp ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �9 No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [K No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C&No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
[5t No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANO
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings `' ,' - ;
a
Page 3 of 3 12/28/04

vision of Water Quality 7— 009 v/
Facility Number 0 Division of Soil and Water Conservation �T• C
O Other Agency
Type of Visit t6ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit GHI-utine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: T fS County'
Farm Name:914W _ Q Owner Email:
Owner Name- -/�Il Le phone
Mailing Address:
Region: 1—C"
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �S- Integrator:'1�'/'YS��tC
Certified Operator:i vv�--r _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =1 = u Longitude: 0 O =I = w
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current .' Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Carre
Cattle . Capacity Populai
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2Q No
❑ NA
❑ NE
❑ Yes
§0 No
❑ NA
❑ NE
12/28/04 Continued

W
Facility Number: —& _ Date of Inspection 7"S`
❑ Yes
19 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
CA No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yup
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J0 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
allo
❑ 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 ;K No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Jallo ❑ 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 NNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;ELNo ❑ NA ❑ NE
maintenance/improvement'?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
19 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
IR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
(,. 50n a�pv.
ReviewerAaspector Name v Phone:
Reviewer/Inspector Signature: Date: — O %
12128104 Continued
%V

i Facility dumber: a f] Date of Inspection
Reg uired Records_ &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps [:3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ 0 -Yes Ufa ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 14 No ❑ NA ❑ NE
23. If selected, dial the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E4 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 CA WMP?
❑ Yes
(KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[4 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
V4 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
10 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Di No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

l
I
Type of Visit O -Compliance Inspection U Operation Review U Structure Evaluation o Technical Assistance
Reason far Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: riS'Q Arrival Time: Q Departure Time:�3 : County �1
Region:
Farm Name: K4q-Owner Email:
Owner Name: L Phone:
Mailing Address:U�`2 M 12 6 e- eZ-; nj�3?'°` AJ 6, 429 ' at --
Physical Address:
Facility Contact: ra aS__ Title:
Onsite Representative:
Certified Operator. L
Back-up Operator:
Phone No-,
Integrator: 2ati?'� cr-+rte
067
Operator Certification Number:Ow--l-3
Back-up Certification Number:
Location of Farm: Latitude: = o = I ="
Longitude: = ° ❑ I ❑ 4
Discharges +& Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Current
Design Current
4C2ttle
Swine
Capacity Population Wet Poultry
Eapa�city P�apulatian
Capacity Population
❑ Wean to Finish
❑ Layet
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Wean to Feeder
n -La er
❑ NE
❑ Dairy Calf
Feeder to Finish
drip
r
❑ Dai Heifer
Farrow to Weanpry
❑ Farrow to Feeder
poultry
'y
�1 7Z.
❑ D Cow
❑ Non -Dai
❑ Layers
❑ Yes
W No
❑ Farrow to Finish
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ Non -La era
❑ NE
10 Beef Feeder
❑ Boars
❑ Pullets
❑ NA
❑ Beef Brood Cowl
other than from a discharge?
❑ Turkeys
'
�.• - ..., s
Other
❑ Turkey Poults
12/28/04
Continued
❑ Other
10 Other
Nuinber�of'Structures:
Discharges +& Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
0 Yes
P No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[j�No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
W No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

• Facility Number: — Date of Inspection 04(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 4 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
PQ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
15.
Does the receiving crop and/or land application site need improvement?
9. Does any part of the waste management system other than the waste structures require [] Yes
�No
El NA El NE
maintenance or improvement?
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑
Waste Application
No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Q No
❑ NA ❑ NE
maintenance/improvement?
® No
❑ NA
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
NJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
JQ No
❑ NA
❑ PAN ❑ PAN > 10% or l0 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) ZMit,& Fire/5 �zrsLC.
13.
Soil type(s) , j'
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑
Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JQ No
❑ NA
❑ NE
ti
Reviewer/Inspector Name ,.��� Phone` {$�
Reviewer/inspector Signature: Date:
11128/04 Continued

• Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check. ❑ Yes 1�9No ❑ NA ❑ NE
the appropirate box.
❑ WUP [:1 Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U(No ❑ NA EINE
❑ 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 LOW
M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�RNo
❑ NA
❑ NE
Additional Cummenfs aodlorf+Drawinb
M a'_
y , a61
12128104

0
Division of Water Quality
xyF
Facility Numb& � � G 4Z Q Division of Soil and Water Conservation
i
7��,i "
j - ----- — O Other Agency x
:; �n.
❑ NA
❑ NE
Type of Visit 40 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up Q Referral Q Emergency O Other
Q Denied Access
Date of Visit: S"�.tS�aa Arrival Time: %%: 1t departure Time: County:5 a�.10-rr aAJ Region: FX 0
Farm Name: .+ _ YY1r -_ a,,.1L Qe_Xs_ H oa s Owner Email:
Owner Name:_ �rd»w ". /<ar..�.�a, y a Phone: 9 to 3 SS- 5.�t 1 cell
Mailing Address:�> LQ7_ 1270s 1c�_vcw
Physical Address:
Facility Contact:
Title:
Onsite Representative: A on •.%: c. M
Certified Operator: _ R a m V%,% c_
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: pr a ska n e
Operator Certification Number: 17843
Back-up Certification Number:
Latitude: =0
='
Longitude: 0 ° = 0 N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 10 Non -Layer
® Feeder to Finish S' .2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai q Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ED
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. Docs discharge bypass the waste management system? (Il'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?
Zya—' -,. t'�V
5'10 - -3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NF_
❑ Yes
❑ No
❑ Yes
CA No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
12/28/04 Continued

I
Facility Number: gJ, — (per Date of Inspection
Waste Collection & Treatment
13. Soil type(s) !Sb ,a C%
T '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No Cl NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure,l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: l
❑ Yes
® No
Spillway?:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
Designed Freeboard (in):' r 191,
/ —
❑ NA
❑ NE
Observed Freeboard (in): rQ S "
❑ Yes
m No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion. seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[] Yes
[ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&I No ❑ NA EINE
maintenance/improvement?
IL _ 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) Crora+. S 8 A. A is
13. Soil type(s) !Sb ,a C%
T '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/InspectorNameUm;rr Phone:
Reviewer/Inspector Signature: Date: .S'/ -7F/0 J-
12128104
/0J-
12128104 Continued

r
Facility Number: g2 — (rDj Date of Inspection S/1r/ter
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiI Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Otber Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�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
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office ofemergency 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.Cdiiimen- audb`r`'Drag*ln s
"
No p u t" p i >^T j^► c. a
6 ee." cto Aj ` o K
v,,
12/28/04

Facility Number: — (po
Date of Inspection >q•o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 900
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes ©' -
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 rnaintenancelunprovement? ❑ Yes t.'3<o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Mgco
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑-Ko
elevation markings?
7
Reviewer/Inspector Name Qin:.. f Tp
Waste A lication
Reviewer/Inspector Signature: Date:
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 -go
I i. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
(+]� -No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type d , .7ox Aeg., 1►/` ger. �a . _ M111 A, ,Ia l �, S.,.,n r /
AIP LA41
y
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
EM o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[moo
b) Does the facility need a wettable acre determination?
❑ Yes
EKo
c) This facility is pended for a wettable acre determination?
❑ Yes
Lilo
15. Does the receiving crop need improvement?
❑ Yes
[4'0
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®-Wo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EWo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes UNo
Air Quality representative immediately.
;,Comments `{refer to gaeshoa #} 6 Facplauni nay YES.sa�nswers aadfar any` recommendations or any outer cam,utents
# 7r : .a FA F � G '%Ti+T^ uz— - .? p. _ 31 ..i., _ x., h � _ .. a. .:.: ..Tse..,. -...-.:.L ...swxwaw�.i.w 4+•......,�-b---3
,Ilse drawings of facility to better cxplarn sttua�ons. ( addrhonal pages as necessary) � � Wield Copy ❑ Final Notes t � � e
:. �_•-e:. - '-'z.---_�..... .. aacaw�s... ..-._ �...... w..:^ �'-,y'-{': �. ��;.....:..,._.—�_�:==--.-.�:...,. -s�. .. :-. -5 .,..r .. ,.. „-^T` �.� :.W _.?...e -�r`a. �.:�.: ���'--
7
Reviewer/Inspector Name Qin:.. f Tp
-3arll . �--
Reviewer/Inspector Signature: Date:
12112103 Caniinued

r Facility Number: $2 _ t;02 Date of Inspection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
x'33 00re SGS WoV-ha u„� LJVA% e selr ve Serf 445 A70-i-
otPn
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
e"Cr Cp�y,
(ie! WIT-, checklis4, desigm, ma etc.)
❑Yes
E] -No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZING
❑ Waste Application❑ Freeboara ❑ Waste Anai�ysis ❑ Soil Sampling---,*"
y irr a-aY o. JF/
24. Is facility not in compliance with any appllcz a setback criteria in effect at the time of design?
❑ Yes
B -No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
swo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑-Ko-
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
&No
28. Does facility require a follow-up visit by same agency?
❑ Yes
Delo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Q-Y�e_s
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
a??o
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
9-N
34. Did the facility fail to calibrate waste application equipment? ❑ Yes D,bie-
35. Does record keeping for NPDES requiredforms
need i%m ovement? If yes, check the appropriate box below. ❑ Yes ❑�
❑ Stocking Form Crop Yield Fordr ❑ Rainfall ❑ Inspection After 1" RaiA---
❑ 120 Minute Inspection Annual Certification Form--'—
E3
orm✓
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddtttotial Comme:tts and/or Dravngs
x'33 00re SGS WoV-ha u„� LJVA% e selr ve Serf 445 A70-i-
otPn
e"Cr Cp�y,
12/12103

Facility Number:---ij�Lj
Division of Environmental Management `� r
Animal Feedlot Operations Site Visitation Record
Date: 9
Time: 12
General Information: t�
Farm Name: I S� County:
Owner Name: T -e -sr �c 5 Phone No:- �{
•n Site Representative: Integrator: Q
Mailing Address: 14-1 i A wam Y,� 1 5tU+
o. IV C� Z,3 3 z
T—
Physical Address/Location:-
Latitude: 1 1 Longitude: I I
Operation DegCription: (based on design characteristics)
Type of Swine No. of Animals Type of Foultry No. of Animals Type of Cattle No. of Animals
0 Sow 0 Layer 0 Dairy
O Nursery 0 Non -Layer 0 Beef
0 Feeder
OtherType of Livestock Number of Animals:
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Faa<lit-y Inspection:
Lagoon
Is lagoon(s) freeboard less than Ifoot + 25 year 24 hour storm storage?: Yes 0 No.d"-
Is seepage observed from the lagoon?: Yes 0 No l
Is erosion observed?: Yes 0 No C
Is any discharge observed? Yes © No i7' �
❑ Man-made Q Not Man-made
Cover Crop ✓
Does the faciliy need more acreage for spraying?: Yes © No ❑
Does the cover crop need improvement?: Yes Q No
( list the crops which need ' rov meet)
Crop type: Acreage:
.Setback Criteria
Is a dwelling located within 200 feet of waste application? Yes U. No C
Is a well located within 100 feet of waste application? Yes 0 No EI
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes 0 No 0
Is animal waste land. applied or spray 'imigated within 25 feet of Blue Line. Stream? ..Yes ❑ No
AOI — January 17,1946 r..., s .. .

Maintenance
Does the facility maintenance need improvement? Yes ❑ No El
Is there evidence of past discharge from any part of the operation? Yes ❑ No ©-
Does record keeping need improvement? Yes a No
Did the facility fait to have a copy of the Animal Waste Management Plan on site? Yes D No Q
Explain any Yes answers:
cc: Facility Assessmew Unit
Drawings or _ Observations:
e
Date: -2- -�
Use Attachments if Needed
4M -7/73�'
will• ., �..
AOI — January 17,1996
' �h�--• �. � _1 - � ti i 4 'L...S+ i.1 A.��wr�•..l y�-r w o ...