040008_INSPECTIONS_20171231

Type of Visit: ®Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j Arrival Time: Departure Time: County: aG' Region:
fix
Farm Name: t� Owner Email:
Owner Name: 1�4(-�f`�,�^ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: y
Certified Operator:
Y
% Title:
Phone:
Integrator: A,014,1�-e°e
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
gest
Swine Capacity Pop.-Piuttry
ga Carrent�Fl_ayer
o Finish
_
rDai
FaFN
Design
Capacity
Current
Pop.
3 Design Current
Cattle Capacity Pop.
Cow
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
o Feeder
Dai Calf
❑ Yes
to Finish
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DW R)
Dai Heifer
to Wean
I
NA
Design
Current
Cow
to Feeder
D . 1'onit . ` ,
Ca
Pop.
Non -Dairy
to Finish
Layers
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Beef Stocker
Gilts
Non -La ers
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Feeder
Boars
jPullets.
❑ NE
of the State other than from a discharge?
Beef Brood Cow
Turke s*
-
Othe
urkey Poults
Other
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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 DW R)
❑ 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, noti fy DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/21715 Continued

f Facility Number: - Date of Inspection:
❑ Yes
No
❑ NA
14. Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & Treatment
❑ NA
[—]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yeso
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ NA
[—]NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
P NA
❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
Observed Freeboard (in):
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
E]NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesrX
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yeso ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. p Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r -6;c -pe ` 1 a� �� N ' �O 41 - � D
Type(s): Octot r
13. Soil T s : f � _ H
❑ Yes
No
❑ NA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesNo
❑ NA
[—]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [SjNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [)I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes y
No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili iNumber: yj-I Date of Inspection-
24.
ns ection-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
*o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
E]Yes
� No
[] NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
►] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the sae agency?
m
❑ Yes
No
❑ NA
❑ NE
Comnneats (refer to question 4) Explain any YES answers and/orany additional recamaiendations or; any otherxcontmeuts. , I
ICI ! -,I Ms3- i{{ E "I� I:, :.�I
�.easa��a�.:�:....
7
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

Divi"sioo of Water Resonrees
Facility Number -WO Division of Soli and Water Conservation
© Qther Agency
Type of Visit: I* Compliance Inspection 0 Operation Review Structure Evaluation O Technical Assistance
Reason for Visit: a Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: LD .00i&!n'J County: soq&` y"
Farm Name: t� Owner Email:
Owner Name: 111 `n Phone:
Mailing Address:
Physical Address:
Facility Contact: �a}t (^- 1
1.�
Onsite Representative:
Certified Operator: N
Back-up Operator:
Location of Farm:
Title:
Region:
Phone: l
Integrator: / 4)vWlm 6,;..444
�0 1
Certification Number: 1 (06 1
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
�NA ❑NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA C] NE
Page 1 of 3 2/4/2015 Continued
Design Current
Design
Current
Design Current
SwineCapacity
Pop.
Wet Pflnitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ea sci
P,o
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r1l3eef Brood Cow
,�
.,....,, .-.
.... ..... -
'
Turkeys
.dM'AA
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
�NA ❑NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑NA C] NE
Page 1 of 3 2/4/2015 Continued

Facili Number: V - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No F NA ❑ NE
Strucre l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F 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 D] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I 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
n Outside of Acceptable Crop Window ❑ Evidence of Wipo Drift ❑ Application Outside of Approved Area
12. Crop Type(s): FSmue C Lias -01 f f it�c>(
13. Soil Type(s):
lOn
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
TT
❑ 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
® 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
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall El 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
th No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

FaciliNumber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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?
Eomments {reierto question #!) Eiiatn say YES answeirsati
`c
u �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
T) No
❑ NA
❑ NE
❑ Yes 1P No
❑ NA
❑ NE
�] Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
Phone: C110453-5300
Date: 27 l
2/4/2015

Type of Visit: 48 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: p '/ Departure Time: �County: Region: AeD
Farm Name: �Pa l . kl% w w Owner Email:
Owner Name:Jth-,In _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: KP—L),M&:�k Title: Phone:
it
Onsite Representative: Integrator: m {...o may,
k
Certified Operator: Certification Number: h ��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Design Current
❑ NA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pouitry
Capacify
Pop.
Cattle Capacity Pop.
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
Wean to Finish
10 NA
❑ NE
La er
airy Cow
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
r:Wean
to Feeder
3
❑ NE
Non -Layer
[:]Yes
[)q No
❑ NA
Dai Calf
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Feeder to Finish
❑ NA
❑ NE
of the State other than from a discharge?
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
I Beef Brood Cow
Turke s
-
�ther•
Turkey Poults
Other
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
F] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
(P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
10 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
[)q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[P No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FRachity Number: U - Date of Inspection: (�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [� NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 3�
❑ Yes
® No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
[ No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
V. No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes]
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Waste Application
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.r
❑ PAN ❑ PAN > 10% or 10 lbs. D. Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
F-1Outsideof Acceptable Crap indoor ❑Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): �PS R 1�JI { t C_ - C,__&�__
13. Soil Type(s):
NE
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]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[]o No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/412014 Continued

Facili Number: IDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes © No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑NA ❑NE
❑ NA ❑ NE
0 N E] NE
❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes M No
❑NA ❑NE
❑ NA ❑ NE
Reviewer/lnspectorName: �rzQ Phone: J/e-y7�7-53Cho
Reviewer/Inspector Signature: a {;t ! Y V I Date:
Page 3 of 3 21411014

r)
i ype or vistr: w uomptjance inspection v vperanon xevtew tJ btructure t;vatuanon V i ecnmcat Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of visit: 51 Arrival Time: QM Departure Time: Q. County: /vyON Region: /;RV
Farm Name: Q`Xh`I�'[� M Owner Email:
Owner Name: eA K � � Phone:
Mailing Address:
Physical Address:
Facility Contact: Kev&' /l" -V- Title: Phone:
p
Onsite Representative: Integrator: &liq
Certified Operator: Certification Number: 1 fOb6 1
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes No [] NA C] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ER NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued
Design Current
Design
Current
Design Current
RaftlePoul#ry
Swine
C apacity Pop. R'et
Capacity
Pop.Capacity
Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
` -_ -`-
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . Pouitr
Ca achy
Pio .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthe
ur ey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes No [] NA C] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ER NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

I'Facility'Number: - Date of Inspection; Z�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
tt
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes�]Q
No
❑ NA
❑ NE
maintenance or improvement?
/L
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo E]NA
❑ Excessive Ponding E]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
�-L;)l K i t4� 1 so,, �
12. Crop Type(s): ��<-.C. 6S
❑ NE
13. Soil Type(s): 11_1 _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes �E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes W 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 [� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes [P No ❑ NA ❑ NE
the appropriate box.
❑WUP E] Checklists []Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes [N No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 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
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acili Number: jDate of Inspection:
CV No
❑ Yes
No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
T
T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Pq No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes O No [DNA ❑ NE
❑ Yes � No ❑ NA 0 NE
[—]Yes
CV No
❑ Yes
No
[:]Yes
[ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any. YES answers and/or any additional recommendations.or any other comment�r fi '
Use drawings of facility --to better explain situations {use additional pages as necessary
cllnq . I(1 �o2Z- i sa g con- c�ep1 -P7s�12
5� " "�7
,5 �5 Ae 5.�Q ce_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I 1b,'{3 3300
Date: 2
214/2011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j Arrival Time: 4 Departure Time: i o so0 County: i>1 Region: FM
Farm Name:
Owner Email:
Owner Name:,Phone:
Mailing Address:
Physical Address:
Facility Contact: U 'yy t y 6-417" Title: Phone No:
Onsite Representative: H Integrator: MLLr,2
Certified Operator: Operator Certification Number: bl,
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I=" Longitude: 0 ° =I = u
at"D ig
Design Current
Design Current
Swine
Capac ty Populaho1l
r n
Wet Poultry `Capacity Population
,."
Cattle. Capacity Population
El Wean to Finish
er
❑Dai Cow
❑ Yes
Wean to Feeder
NA
EON n -La er
❑ Dai Calf
❑ Yes
El Feeder to Finish
[?NA
,11`111.
Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Yes
❑ Farrow to Feeder
'`'tjf
Non -Dairy
2. Is there evidence of a past discharge from any part of the operation?
El Farrow to Finish
No
❑ La ers
❑ Beef Stocker
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Gilts
No
❑Non -La ers
❑Beef Feeder
other than from a discharge?
❑Boars
❑Pullets
❑Beef Brood Co
Page I of 3
• .: -
Continued
El Turkeys
other
= =
0 Turkey Points
J,JE] Other
❑ Other
Number of Structures:
"
s..
,�'v.'.
,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CTNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[?NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[;�)NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/18104
Continued

Facility Number: — Date of Inspection
Soil type(s)
WeA(
Waste Collection & Treatment
k6
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ffNo
❑ 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:
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
Spillway?:
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
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
[&No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
m No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
iN No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® 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) �� Cha 5 '� 1 Qlx-fr� s+k • �1
13.
Soil type(s)
WeA(
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
`[�
❑ NA
EINE
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
t 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
11 11 "
Comments (re_fer to questt#)apl nyY{ES answers andJor au y recommendations or any other comments.
i u :..
Use drawings of faculty oto=better expham s�tuahons. (ase additional pig necessary):
WeA(
Reviewer/ll Qnspector Name �- ^ - _ — Phone: 1'9 y3 9F3V
Reviewer/Inspector Signature: Date:c3 l
Page 2 of 3 12/28/04 Continued

_ t
Facility Number: — Date of Inspection
Required Records & Lcuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �{ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
i] 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
19 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
NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesIII,�y
No
C1NA
ElNE
and report the mortality rates that were higher than normal?
(�1
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ 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
Page 3 of 3 12/28/04

Type of Visit 0 Compliance 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: Qa r" Departure Time: County: Region:
1
Farm Name: �%f n►, Owner Email:
Owner Name: _. Kex/+ n I ' I Lu-�i� Phone:
Mailing Address:
Physical Address:
Facility Contact: I���� to✓`�'� Title: Phone No:
tl �n
Onsite Representative: Integrator:
Certified Operator: Operator Cer#ification Number:
664
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1
=" Longitude: 0 ° = f I=] 1
1
DesignCurrent
Design Current
Design C*anent
Population
Wet Poaltry Capacity Population
Cattle Capacity Population
an to Finish
❑ La er
❑ Dai Cow
anto Feeder C."�
FFWe
❑ Non -La er
❑ No
ElDai Calfder
to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Dairy Heifer
El Farrow to Wean
Dry Ponhkry
ElD Cow
El Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
Non-ts ars
El Stocker
Gilts
❑ No
Beef
[IBeef Feeder
PE113oars
El Pullets
El Beef Brood Co
[f No
❑ Turkeys
❑ NE
Other
❑ Turkey Poults
qNo
❑ Other
❑other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
to No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[PNA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
q 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
qNA
❑ NE
?. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[f No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
qNo
❑ NA
❑ NE
other than from a discharge'?
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 1 Structure 2 Structure 3 Structure 4
Identifier: ' 1
❑ Yes No
❑ Yes No
Structure 5
❑ NA ❑ NE
] NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7i Z
5_ Are there any inunediate threats to the integrity of any of the structures observed? ❑ YesNo [:1NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes J9 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 12 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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 C&No [:INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [_1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or ]O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13_
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
§N No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
EINE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IP No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
I] No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer -to question #). Explain any YES answers and/or ahv"recommendations or any other,t�comments
Use drawings of facility to better explain situations (use addition pages as necessary) _
�.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
12/28/04 Continued

Facility Number: Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 110 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" Dain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IP No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9 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
0 No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
RINo
El NA
El NE
If yes, contact a regional Air Quality representative immediately
r-
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
fpNo
❑ 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
12/28104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival
Time: I 00P M Departure Time: 140f.,y County: � Region:
Farm Name: it ►``tr��1 Owner Email:
Owner Name: VP.v'A A IU4-i1' _ _ _. Phone: C nil) 8a 6 -999a
Mailing Address: — _ [ j0q) 6qs-5711
Physical Address: ,/
Facility Contact: jeeV,�, A/ka144h Title: Phone No:
PI
Onsite Representative:
I
Certified Operator:
Integrator:
Operator Certification Number: 166e9
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I 0 G Longitude: I=] ° = I = W
J
Design Current
Design Curren#
Design Curren#
Swine Capacity Papulation
Wet Poultry Capacity Population
Eattle Capacity Population
Wean to Finish
❑ Layer
❑Dai Cow
❑ Yes
Wean to Feeder 3Ss•Z t7G10
❑Non -La er
❑ NE
❑Dai Calf
❑ Yes
Feeder to Finish
§§ NA
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
ir
❑ Non -Da'
❑ No
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Yes
❑ Gilts
❑Non -La ers
❑ Beef Feeder
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Boars
❑ Pullets
10Beef Brood Co
ElNE
other than from a discharge?
❑ Turkeys
Other
❑ Turkey Poults
Page 1 of 3
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EjNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
E�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
J9 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
EA No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ YesNo
71
ElNA
ElNE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

'[Facility Number: — Date of inspection
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
Q9 No
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
%No
❑ NA
EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
(ANA
❑ 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
tp 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
�LNo
❑ 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
A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes INLNo [INA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes &No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes qPNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes jEgNo [INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El
El Evidence of Wind Drift ElApplicationOutside of Area
12. Crop type(s) QSG� CPQ / M.OF
E 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
qNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
Q9 No
❑ NA
❑ NE
Wed �A�m�,A ��,,, . cce;,d rer&-ds ,
Reviewer/Inspector Name F P464'77m"4_ Phone: 91PIr 33 3 0D
Reviewer/Inspector Signature: Date: ,3 75)"D
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection o�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fS No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ej 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
kNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
.9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
)QNo
❑ 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
*c,
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
ANo
❑
32. Did ReviewerlInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Additional Cnmmets,andlor Drawin��= ; q
Page 3 of 3 12128104
Page 3 of 3 12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 1 QQi Arrival Time: SCJ Q N7 Departure Time: County: A'—C-OA' Region: PAID
Farm Name: A_ -vi' - Acw4—i^ Fct.•n, — --- - Owner Email:
Owner Name: V=C'! 1kn Phone:
Mailing Address:
Physical Address:
Facility Contact: t"�h� _ Title:
c�
Onsite Representative:
Certified Operator:
Back-up Operator:
K
Phone No:
Integrator: f- Q
Operator Certification Number: 1 (o6 1
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
=61 Longitude: =0=1
°=1 = «
Design Current
Swine Capacity Popu1 en
❑ Wean to Finish
Wean to Feeder 35�yl
Ll Feeder to Finish 9716
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
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?
Cattle
Design Current .:
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes to No ❑ NA ❑ NE
❑ Yes
❑ No
CNA
❑ NE
❑ Yes
❑ No
IF NA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128/04 Continued

Facility Number: Date of Inspection Ir 0
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[S No
[INA ❑ NE
Waste Collection & Treatment
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes EP No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
[P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Soil type(s) 536LA
Spillway?:
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
Designed Freeboard (in):
Does the receiving crop and/or land application site need improvement? ❑ Yes
to No
❑ NA ❑ NE
Observed Freeboard (in): �.1rj N
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EP No
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes I1No
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
II
tp No
❑ NA ❑ NE
6_ Are there structures on-site which are not properly addressed and/or managed
❑ YesNo
ElNA
ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [:INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes tP No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes '�No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[S No
[INA ❑ 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 Drifi ❑ Application Outside of Area
12.
Crop type(s) aS_ Srv�, (y .Ce.re All&
13.
Soil type(s) 536LA
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
to No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EP No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
PNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
tp No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
604 Ft4lw ,
k«d 4y'�3 .
Reviewer/Inspector Name Phone:
Y33 — o0
Reviewer/Inspector Signature: Date: V08
12/28/04 Continued

Facility Number: — Date of Inspection t t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps [:3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
ERNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M 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
f5g No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
V No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Qg No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
to No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: N l AD7 Arrival Time: 0$i 00" Departure Time: .20Qrr, County: SON Region:
Farm Name: kw nM
"'�+ 1f�� n Owner Email:
` ,1 n e
Owner Name: I M'�'t'1�r1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Keay o Mq4 M44n Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ C ❑ « Longitude: ❑ o = i =
cd
Design Current
❑ Yes
Design Current Design Current
Swine Capacity Papulation
Wet Poultry
Capacity Population Cattle Capacity Population
❑ an to Finish I❑Layer
❑Dai Cow
Wean to Feeder `eZ$CO
I❑Non-La er
❑Dai Calf
❑ Feeder to Finish
R NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poltry
r; E]Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
2_ Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
No
Other
❑ Other
❑ Turkey Poults
❑Other
Nuni[iet-of $#ruetures:
❑ Yes
[*No
❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
R NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
KINA
❑ 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
M NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[*No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128/04
Continued

FacililyNumber: — Date of Inspection 1 /
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?
StruIture 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-15'~
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 1�4 No
❑ NA ❑ NE
❑ Yes ❑ No
P NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes QU No
❑ Yes ['No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes F No [-I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes(� No El NA E] NE
maintenance or improvement? 1
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 4 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q 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
j S.�l . �-. Cave✓, ` J
12. Crop type(s) �- � �S`'fur"_�-� � ' v "' �! 4
13. Soil type(s) "_�6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes n No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/inspector Name
❑ Yes
❑ Yes
Reviewer/Inspector Signature:'EER0_4LL p Date:
Page 2 of 3 I
® No ❑ NA ❑ NE
No ❑ NA ❑ NE
1PNo 0 N [I NE
V1No 0 N El NE
Continued

Facility Number: — Date of Inspection 110
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 50 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JA No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V3 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
�D No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes]
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
El 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
[I Yes
P1 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
V] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
w
Page 3 of 3 12/28/04

7
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up - 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �- �� Arrival Time: / ,' V 0 Departure Time: E) I County: Region: D'
Farm Name: ,� d r` rt. /// Ltf`�%� _ i Qr Owner Email:
Owner Name: 2- L + -A-- Phone:
Mailing Address:
Physical Address:
Facility Contact: 21 C_ _ Title:
Onsite Representative: Ste*
Certified Operator: S42>I-,-
Back-up Operator:
Phone No:
Integrator:
Operator Certifica 'on Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =, = « Longitude: =0=4
°=4 0
66
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I I❑ Layer
Wean to Feeder Sfl j JLJNon-La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other ...— --
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Populatwh ;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifez
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
RQNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
&No
❑ Yes
(KNo
❑ NA
❑ NE
❑ Yes
9LNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes CK No ❑ NA ❑ NE
❑ Yes [§ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C& 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 0 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 ;3 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[KNo
❑ NA EINE
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
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence off Wind Drift ❑ Application Outside of
Area
12. Crop type(s) �iyi,.�®Gra. •� SiL c /%yl; ��t / T<,rf�, �z��Grrc' �ss�_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eq No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
52 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J&No
❑ NA ❑ NE
Reviewer/inspector NamePhone
Reviewer/Inspector Signature: Date: —[7
12/28/04 Continued

Facility Number: `' Date of Inspection 'o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [9Yes ❑ No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 91 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ®.Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U 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
04 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
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X] NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E[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
4No
❑ 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
ffNo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZINo
❑ NA
❑ NE
AddrhonairCoainents andlor 1Jrawtngs ti" ` �° k4 b �h
i9 C €>C_
12128/04

I. %
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
treason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
t Date of \visit: w o Time: D
Facility• lumber t
.... Not O erational 0 Below Threshold
O Permitted ©Certified ©Conditionally Certified 0 Re-_istered Date Last Operated or Above Threshold:
Farm Name: _ 14'e U, h MacLn & r"' Count)-: 6 Fig
Owner Name: Phone No: 704 _ZI.L 3
Mailing Address: �: S r.S m 1i' i Qa /11,,,G. _;�i�o0 (.
Facilin- Contact-. 4%N n 04 ar ;^ Title:
Onsite Representative: --
Certified Operator: _ ke.JI A k_XA 6,L6 V,
Location of Farm:
Phone No:
Integrator:_C c_nr•o if Vis'
Operator Certification Number: _ I_ L G ('. �
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° u Longitude ' �•
Design Current
Design Current Design Current
Swine Ca acity Po elation
Poultry
Ca acitf Population Cattle Ca aciri• Po tdation
Wean to Feeder3 X5.1 S � D7
10 Laver
❑ Dairy
❑ Feeder to Finish
113 Non -Laver
1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow" to Feeder
❑ Other
Farrow" to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ILI Subsurface Drains Present ❑ Lagoon Area ❑ Sp rav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
Discharges S Stream impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Wer e there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Strucr= 1 Stnrcrtue 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05/03/01
El Yes F11' No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
❑ Yes 13 No
Structure 6
Continued

Facility Number: — Date of Inspection 1 d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 5 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes R No
12. Crop type e G
13. Do the receiving crops dimer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes © No
16. Is there a lack of adequate waste application equipment? ❑ Yes P No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fr7" No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
(3No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
QNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
[�j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
}Comments (refer to q on # .Eip1a� any YE swers andlor any recommenF dations any Wer com nfs a� p ja i
aMn-
Used -,
gs 6f faiiiltty�toibei#er�eaplam srtuaEtons=(use adifitinnaI pages awn&Rsary) _ ❑Field Copv~
„r r
.til ­ .. t"-'�av:r._
❑Final Notes
&S,001, J MCp r -j ­v 4- 4�r-. 16th- Ve( Jcxrs J- %
Reviewer/inspector Name j
Reviewer/Inspector Signature:
05/03/01
Date:
Continued

Facility Number: +¢ — C Date of Inspection a r o
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes ❑ No
❑ Yes [�d No
❑ Yes ®No
❑ Yes [S No
❑ Yes ® No
❑ Yes [XI No
M Yes ❑ No
-Additiona]Coui&i ibtA4gdf_d_r Dramn �
O5103101
O5103101

Site Requires Immediate Attention:
Facility No. 04 -9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITAT1ON RECORD
DATE: TJX 29 1995
Time: to : %o
Farm Name/Owner: lie.
-Mailing Address: p. n
County: h�Nson
Integrator: NA —
On Site Represents ive:R,_3
Physical Addressn ovation:
Phone:
C w .1L AL 1.L.w fC"'1' Z GD 1 i.':) 7
Type of Operation: Swine x Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: .S ° jg' P " Longitude: 80 ° 04'_g?
"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) ®or No Actual Freeboard: 4,.z-2 Ft. _Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or�seepage was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Crop(s) being utilized:_ „ (Spray Field or cover crap was not evaluated) _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? mor No
100 Feet from Wells��Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, orm+ther
similar man-made devices? 'Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No(Waste management records were not
Additional Comments:
This was a very brief inspection. a more thorough inspection will be conducted in the future.
Please contact�.DEM should any condition -arise that poses a danger to surface waters.
* This farm was not located on a USGS TOPO map to determine ?Blue Line" status.
If you have questions concerning this report please do not hesitate to contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.