090022_INSPECTIONS_20171231

Type of Visit: (4 -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .9'`toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; Arrival Time: X00 Departure Time: County: Region -1
Farm Name: U� $ �Oys Owner Email:
Owner Name: �p►1G.1� flu yS t� Phone:
Mailing Address:
Physical Address:
Facility Contact: 13 lknff'rTitle: Phone:
t
Onsite Representative: 1 Integrator: 09--c
Certified Operator: o ✓ -- iYA S, S t Certification Number: -16 e-7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
❑No
Design
Current
Dtsign Current
Swine Capacity P,op.
Wet Poultry
Capacity
Pop.
Catty le Capacity Pop.
Wean to Finish
Layer
Dair Cow
Wean to Feeder I
lNon-Layer
I
Calf
Feeder to Finish E7 • so0
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult ,
Ga ac'
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes I3NC ❑ NA ❑ NE
[:]Yes
❑No
[3 -NA
[] NE
❑ Yes
[] No
g -KC
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No E] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3 -No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [] N ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - 'Z -f Date of los ection: 4 OC!
[j No
❑ Yes
ED -No
❑ Yes
Waste Collection & Treatment
❑ Yes
G]'1Go
❑ NA
❑ NE
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists El Design ❑ Maps p Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[]Ko
❑ NA
Observed Freeboard (in): 3
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi I Analysis
❑ Waste 'transfers
❑ Weather Code
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2 -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff'No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[KKo
❑ NA
❑ N E
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 ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �[.r� Le- �`i '560 . ( 1
13. Soil Type(s): 4. F; 6
0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes
[j No
❑ Yes
ED -No
❑ Yes
[3'1Go
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q I'do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
G]'1Go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[2 -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q' <o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps p Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[]Ko
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi I Analysis
❑ Waste 'transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2114o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff'No
❑ NA
❑ NE
Page 2 of 3
2/412015 Candnued

Facili Number: - Z'Z- Date of Inspection: m C
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r�_ 0
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D -Io
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? ❑ Yes �o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes
[9<
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
❑ Yes
is
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ErNo
❑ Yes
[TNo
❑ Yes
[2rNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comuts {refer to gaeshon #) y"11'4
1YES answers and/or any additiooalrecbminendatians or.,'aay¢other6 comments.
II a:�. .d i li iri,.ts Y _::i.l. ��:+a I; i aimn.�r;�i,l
Useldrawings'offidlifW0 better expla�nEsiWat�ons (ase additional pages'as necessary)�!�''Ili 1�I II�i� _Ill, SII
C w ("Girc(r'o�i g �(
Ce-(( cVb- 3o8- 6991
Reviewer/inspector Name: 3 i { D/'11'4
Reviewer/Inspector Signature:i
Page 3 of 3
Phoneq
Date:
21412015

I ype of visit: compliance Inspection V Uperation Review U htructure Evaluation V Technical Assistance
Reason for Visit: O xoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: 17V Arrival Time: /O Departure Timer County: >✓" ' Region
Farm Name: V
./ - 'a
Owner Name: /
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: _f '�se,je Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capaci#y Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pap.
Design Carrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
L JNon-Layer
LH
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
Dairy Calf
0 No
Feeder to Finish7j
Farrow to Wean
Farrow to Feeder
Farrow to Finish
(
D , I;oult
JLavers
Design
Ca aci
Curren#
l;o ,
Dairy Heifer
Dry Cow
❑ NE
Non -Dairy
Beef Stocker
Gilts
[ o
❑ NA
Non -La ers
Beef Feeder
Boars
Pullets
IBeef Brood Cow
O#Wr',*,:.
Turkeys
TurkeyPoults
Other Other
DischarPes and Stream lmuacts
1. Is any discharge observed from any part of the operation? ❑ Yes [J� ❑ 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 DWR)
[:]Yes
[] No
E 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
0 No
ffNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of inspection: / 01VOU
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M -Ne --D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-K ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Bio
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[fNo
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B -Wo-
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
[]WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
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?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
If any of questions 4fi 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
[21<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
2/42015 Continued
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[50'N -o
❑ 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 dNo ❑ NA
❑ 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 WindowQ ❑ � C Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6 ev �l.clXl•( +-., S6 c---)
❑ NE
13. Soil Type(s): P p
&D ,
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes [�]'P'o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? []Yes [y 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
g go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Bio
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R o
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�io
❑ 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?
❑ Yeso
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[TNo
❑ NA
❑ NE
Page 2 of 3
2/42015 Continued

Facifl Number: - Date of inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ga] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-M-0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0-5o ' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Eg-NV❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
G(a 7 -e-�v�
❑ Yes ❑ NA ❑ NE
[—]Yes 10 ❑ NA ❑ NE
❑ Yes E3-�11'_ ❑ NA ❑ NE
❑ Yes 7" ❑ NA ❑ NE
❑ Yes 13 -go
❑ Yes [2.90
❑ Yes [�T_No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
x40.3 t 5
Reviewer/Inspector Name: i Phone: 3-3,30
Reviewer/Inspector Signature: Date: 0 A00 1b
Page 3 of 3 2/4/2015

type or visa: t(2 to7ijance inspection U uperanon xeview U Ntructure e,Varuanon U Iecnmcat Assistance
Reason for Visit: kzrKoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:�D County: Region.
Farm Name: -7-*I-'t Ej Owner Email:
Owner Name: 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1, Is Title: Phone:
Onsite Representative: k is Integrator: 04 _
Certified Operator: 0,A_ S 1,� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
❑ Yes
No NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Current
Design
Current
Design Current
C2 -NA
SwineCapacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
❑ NE
Wean to FinishLa
er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
D ' Cow
&NA
Wean to Feeder
JNon-La
❑ Yes
er
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
DE!DE!g Calf
D/No
Feeder to Finish 5 3
❑ 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,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
iTurkey Poults
Other
LjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
C2 -NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[ "JNA
❑ 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
E3No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
D/No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Faclli Number: C1- Date of Inspection:
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5Tfo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No [5 -1q -K ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
[3 -Nu
❑ NA
❑ NE
❑ Yes
Spillway?:
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in): "
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[2,N-6
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Frceboard ❑ Waste Analysis 0 Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
QXo
❑ 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<O
❑ 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
0 NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EJ -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
E]" o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D-Nv—
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [3r71ro_ ❑ 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 ❑,Appplliccaattion Outside of Approved Area
12. Crop Type(s): 3 Cf !� c6 C7 , 0"`7 {� ,,Cl a l �
13. Soil Type(s):
14. Do the receiving crops differ Ern those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
1$. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
EINo
❑ NA
❑ NE
❑ Yes
[3 -Nu
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
LJ""O
❑ NA
[] NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Pio-
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ej>v~
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[2,N-6
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Frceboard ❑ Waste Analysis 0 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
[21r
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E]AKo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facilky Number: - Date of Ins ection:
74. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lam— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ INa— ❑ 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
E34iu— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
(tr155' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yeses
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D -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
ELNo ❑ 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
Fo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
❑'Flo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0 -No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L'No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-7 go U.ff
?14/2014

c
3� saes is 01)
Type of Visit:Zutine
'ance Inspection Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: O Complaint Q Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: r 0 County: Var—
Farm Name: H c s Owner Email:
V 11A
Owner Name: 4 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ky Title: Phone:
Onsite Representative: 1 i Integrator: K8
Certified Operator: I t9`t
V Cf
Back-up Operator:
Region: Rzo'
Certification Number: f p2
Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Imnacts
1. is any discharge observed from any part of the operation?
Design Current
[3'4 or
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cai#Ie Capacity Pop.
Wean to Finish
E31NA
❑ NE
La er
❑ Yes
❑ No
[P14
Dai Cow
Wean to Feeder
Non -La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
Dai Calf
Feeder to Finish
6210 6r-
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[Z3<o
❑ NA
Dai Heifer
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Wean
[G"No
❑ NA
❑ NE
Design
Current
Cow
Farrow to Feeder
D , P,oul
Ca aci.
P.o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers.
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
[3'4 or
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
E31NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[P14
❑ 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
f e A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[Z3<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[]Yes
[G"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Ir
Facili •dumber: - Date of Inspection: 1734ttt
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 0 No ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
KNo
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EJ'No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in): 9
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ONO
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[B'1<o
❑ 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
[jKo
❑ 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
[3' V�o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[] Yes
[1l o
❑ 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
2rf�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�,�
io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2Io ❑ 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): —1 Hi P 560
13. Soil Type(s): �Y ti F oo,6Go ,
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
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EJ'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ONO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[
❑ NA
❑ NE
Required Records & Documents
19. Did the faciliiy fail to have the Certificate of Coverage & Permit readily available? Yes [DNo [:]NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3'IV((o ❑ 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 [�No ❑ NA ❑ NE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ff No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection- LhL7 0 IS
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �0 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [91No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
C] 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❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
/
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
U O
❑ 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
Flo
❑ 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
EfrNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J�No
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F(No
❑ NA
❑ NE
Comments (refer to question 4): Explain any YES answers-andtor,any-additional recommendations or any other comiments-
Use drawings of facility to better explain situations (use additional pakes:as necessary).
Reviewer/Inspector Name: _k3 1-4
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4 J S- 3 33
Date: f I s rn 1 5
2/42014

hype of visit: t $bmpliance inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: �outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
. —%a
q730
Arrival Time:
Departure Time: d` County: .�
Farm Name:
�
L6
Owner Email:
Capacity Pap.
............
Wet Poultry
Owner Name:
r.r
101At'
Phone:
Wean to Finish
a. Was the conveyance man-made?
Mailing Address:
Physical Address:
Facility Contact: � X11&- Title: �rC
Onsite Representative:
Certified Operator: y i
Back-up Operator:
I
Phone:
Region: -r(zo
13 c7
Integrator:
Certification Number: 16 .2e7
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
Designs Current
Design
Current
Design Current
❑ Yes
Swine
Capacity Pap.
............
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
a. Was the conveyance man-made?
[—]Yes
✓ No
Layer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Dairy Cow
❑ NA
Wean to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
I
iNon-Layer
I
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
Dairy Calf
❑ NA
Feeder to Finish
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
'1T
❑ NA
" .
Dairy Heifer
❑ Yes
Farrow to Wean
❑ NA
❑ NE
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultr.
Ca aci
Po ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other;;,
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ef'*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
rt_14�o
❑ 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
[ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
'1T
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Cio
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

• r
Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EB -Nm ❑ 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 I ff'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 t reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WNo
E] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 E_1<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B<0 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2<0 ❑ 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): ,441& °I F(S b
13. Soil Type(s): L.... {I"� V ori -
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
G'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 E] Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ijiNo ❑ 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[�10 ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

0 X:� U qC% 1 1.4 0
Facility Number: - Date of Inspection-
ns ection:24.
a
24,Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CVo
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
CD 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
Lf:�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
2'�io
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
U2�10
❑ 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(�Vo
❑ 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
�To
❑ NA [:]NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:)Yes Q.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 [:JiVo ❑ NA ❑ NE
Comments (refer.to question ft Explain any YES answers and/or any additional recommendations.or any other comments
Use drawings of facility fi better explain situations (use additional pages as necessary).
sfte,' SCA�ti
C�.`6 rAor
G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
q, 5e
r)r,c 2() 1 2
Phone ( D -Im-
335f 1
Lod
2/4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Q fl Departure Time: County: Region: )=R_�L
Farm Name:17U L� y G, Owner Email:
Owner Name: HAL iP Phone:
Mailing Address:
Physical Address:
Facility Contact: gilt Title:a� sic Phone:
l
Onsite Representative: ��igir !,(/ �.�; K 5 Integrator:,. y+
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
„ Design Current
Design
Current
Design Current
Swine '' Capacity Pop.
Wet,Poaltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish.571r_0 Ies'
�,.,
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D"Pouifry
Ca acity
P,o
Non -Dairy
Farrow to Finish
Layers
I jBeef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
El jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes f] No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

IFacWty Number: jDate of Inspection:
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo 50A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ f
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
[2, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[::]Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
C3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E3 -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):
13. Sail Type(s):Ly'it y� 7J�YS !` ���Di�/o �Aa, —hs
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
V 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
(A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
En 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
[21 No
❑ NA
❑ NE
the appropriate box.
❑WUP [:1 Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [f, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a 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 [allo
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes [.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [2,No ❑ NA ❑ NE
❑ Yes RtNo ❑ NA ❑ NE
❑ Yes Dg No
❑ Yes ['No
❑ Yes [2 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawings -6f facili to better ex lain situations use additional pages: as nec sary} = any other comitte'uts: `" w
Comments (refer to question#)Explain any YES answers and/or.,any additid"Lreeotnmendations.or
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1%1 a±!2 = `�
Date:
2/4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (61routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z:/1—/ Arrival Time: DDeparture Time: [� County: �- Region: %D
Farm Name: lylzr s: S Samir _ Owner Email:
Owner Name:%� , /iu�1�i1S _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ��lj J�y��, Phone:
Onsite Representative: Integrator: 1"zf'e1-'t7!z -
Certified Operator: ��uf� �� sHs Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
DtyP.oult .
@a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes [@ No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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

Facility Number: jDate of Inspection: 4
Waste Collection & Treatment
`. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):�
Observed Freeboard (in): 3a
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Pq No ❑ NA ❑ NE
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
[E] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[A No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable CropWindow[] Evidence// of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):0"�itl��
13. Soil Type(s): L 6 /b ,4
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?
154 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
RNo
❑ 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
[S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ej 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
CK 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
2/4/2011 Continued

Facility Number: jDateof Inspection:
❑ Yes
JZ No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
r
❑ Yes
[Z No ❑ NA ❑ NE
25. Is the facility out of compliance with penttii conditions related to sludge? If yes, check
❑ Yes
® No [DNA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
® No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
34. Does the facility require a follow-up visit by the same agency?
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[Z No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
r,71 No E) NA E] 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
JZ 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 same agency?
❑ Yes
® No
❑ NA
❑ NE
" a- �­_. I
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better'explain situations (use addittonal' pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 262 -- ll33 _7�jao
Date:
2/412011

///ag /Zo/o rlf-
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Z% Departure Time: =oC3 County: B/qWe._/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: /� ��
Facility Contact: K!�-f�ITUrLX1 Title: �t'h? Phone No:
Onsite Representative: Integrator: A
LL
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] e 0 & E=] « Longitude: = o =' = u
Design Current
Swine Capacity Papulation
Design Current
Wet Poultry Capacity Population
DesignCurrent
Cattle Capacity PopWa11 tion
❑ NE
❑ Wean to Finish
❑ La er
RA
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish d d
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
BNo
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R<o ❑ NA ❑ NE
❑ Yes
❑ No
Q NA
❑ NE
❑ Yes
❑ No
RA
❑ NE
BNA
❑ NE
❑ Yes
❑ No
❑ Yes
Q"NNo
[INA
[INE
❑ Yes
BNo
❑ NA
❑ NE
Page I of 3 11/18104 Continued

Facility Number: 07 — AQ Date of Inspection 3
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?
Stru turc I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
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 [Rigo ❑ NA ❑ NE
❑ Yes ❑ No 01 TA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ONo ❑ 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 ON^o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [140 ❑ 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 2 NO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement? ^
1 l _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E9<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > IO% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? `"
❑ Yes
Q'Ho
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
3"'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETNo
CT [vo
❑ NA
❑ NE
Comments (refer to question .#) Explain any. YES .answers and/or any r 9mmendatroos or any other comments,
Use draKngs?of faci--pages,, es asnecess
ary}tyrsix lan situations. (use-addition
Tri'G �U o�c�y s�r.►.c�cu
15
Reviewer/Inspector Name _ Phone: Com' 3.�
Reviewer/Inspector Si re Date: l/ d
Page 2 of 3 Q 121n104 ' Continued

Facility Number: 4�W — Date of Inspection Ir V
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,<o El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes L7 No [� 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
B o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L7 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[j Yes
❑ NE
E] NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,[�'l�fo
L7 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
BIG
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0"fio
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the pennit or CAWMP? ❑ Yes B04o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EPKo
❑ 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
[R<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31- Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,
t�vo
❑ 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
ED -Ko
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
E o
❑ NA
❑ NE
Additional Comrnersts and/or Drawings: _.
Page 3 of 3 12/28/04

,/
ieuS 7-01r-2001
ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
— - - O Other Agency
Type of VisitCm
opliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0
Reason for Visit Knoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S / %' Oy Arrival Time: 2 • ZQ wti Departure Time: 3' �Q .K County: gladeAJ
Farm Name:r �`«is ��'9N �� Owner Email:
nwnor Nnmr- RoNul+l 11J0C -,,AJC PhnnP-
Mailing Address:
Region: F)w
Physical Address:
Facility Contact: HQ9S11y D 169 AN ✓ ✓ Title: �`�'' �� Phone No:
OF
Onsite Representative: Ka litAw f)u 6a✓ � _ Integrator: &&AV -i___�'"��^r^/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: F --I o =I
Q Longitude: ❑ ° = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I I ❑ Layer
Non -La et . .
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El 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?
Design Curren
Cattle Capacity Populatii
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 ENo ❑ NA ❑ NE
❑ Yes
❑ No
B<A
❑ NE
❑ Yes
❑ No
G -KA
❑ NE
LINA
❑ NE
❑ Yes
❑ No
❑ Yes
[3�o
❑ NA
❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: oq — 22 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ErNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.-
Designed
pillway?:Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LK ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [R<o ❑ 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 D<o ❑ 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 E❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes 3'99- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or ] 0 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) f3L:�..ad�-•- t` 6'za t S:y�t'i G.c,,:.., 0-5.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff, Ngo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
ElNA
[:1NE
17. Does the facility lack adequate acreage for land application?
ElYes
O N'oo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
1�Na
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspectorName �iL ,�e,v�IS Phone: 9/0, 5V33. 333V
-
Reviewer/Inspector Signature: Date: 5-/7-200,7
12/28/04 Continued

Facility Number: p 9 —2 Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [r N ❑ 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
[3 o
❑ NA
❑ NE
EK ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Yes
❑ 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
ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes1/o
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
&<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
12<0
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
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
EK ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo ❑ 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
ElLS
,�,�
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
21< ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,��
32. Did Reviewer/Inspector fail to discuss review/ inspection with an on-site representative?
El Yes
I�No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[bio ❑ NA
❑ NE
Comments and/or Drawings:
12/28104

g �%us tKYWr c� 7— O I— O SIle, k
Division of V4`ater Quali 1_
=Mbi r Q f -- Z 2 O Division ofaSoil and Water- C"onservation
Agency.
Type of VisitCom
Hance Inspection
Q Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
&Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: Z . 1 � Departure Time: Z ; 3 County: SZZAA/ Region: leo.
Farm Name: U'n < .ZNc Owner Email:
Owner Name: /Fqn/Q� 11Mfu
Ci. S Phone:
J
Mailing Address:
Physical Address:
Facility Contact: Al Title: /ti %3 Phone No: D
Onsite Representative:.. Integrator: //K, ,e.�„ ¢ /�7W!✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: latitude: = o = F --I Longitude: = ° 0 0 u
Design Current
Design C*urrent - Design Cnrrent
Swine C►apacity Population
Wet P.oultn•
Capacity Populatony_ C►attle Gapaciiy Population
'U' No
B"
❑ Wean to Finish
❑ Layer
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
El Dai Cow
❑ Wean to Feeder
n -La er
a. Was the conveyance man-made'?
❑ Dairy Calf
❑ No
Feeder to Finish
❑ NE
El Dai Heifer
El Farrow to Wean-
Dn Poultry
❑ Dry Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)'?
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Yes
❑ Beef Feeder
❑ Boars
❑ NE
❑ Beel` Brood Cow
❑ Yes
E❑
L7 No
Other
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
: .
❑ Other
,❑]NA
ENA
*_ Numberof Structures:
Ell
other than from a discharge'?
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Turke Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
'U' No
B"
❑ 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
ETN
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
E❑
L7 No
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
,❑]NA
ENA
❑ NE
other than from a discharge'?
Page I of 3
11/18/04
Continued

Lacilio, Number: pq - OZZ J Date of Inspection /-O
❑ Yes
[�I'No
❑ NA [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[d' No
❑ NA
[INE
a. if yes, is waste level into the structural freeboard?
El Yes
LrfNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Waste Application
Spillway?:
❑ Yes
3No
❑ NA ❑ NE
maintenance/improvement?
Designed Freeboard (in):
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
r�
Observed Freeboard (in): Z
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
L7 No
❑ NA
EINE
(ie/ large trees, severe erosion, seepage, etc.)
12. Crop type(s) o5e -w., dj k c -e_ ) . S
6. Are there structures on-site which are not properly addressed and/or managed
El� Yes
,
IBJ No
❑ NA
❑ NE I
through a waste management or closure plan?
❑ Yes
IT No
❑ NA ❑ 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
[�I'No
❑ NA [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0No
❑ 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
ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
3No
❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
l-7 No
B"
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0%ori 0 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) o5e -w., dj k c -e_ ) . S
13. Soil type(s) Gatd TZ o,.v Ic0r�s4, r _ LVnici,bu►�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IT No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
a' -No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
a -No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D'1<io
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R,&o
❑ NA ❑ NE
Comments (refer'to question #): Expla►p any YES answers and/or any recornmendahans or anv other corriments K
.Use drawings of facility to better explain situations (use additional pages as nt .�
Reviewer/]nspector Name Rs C K . R e V, e,i,S Phone: 9/O, 1f33•330
Reviewer/Inspector Signature: r.... Date: -/7 2,949
Page 2 of 3 11/18104 Continued

Facility Number: O 4 —OZz Date of Inspection �7—D
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 EJ'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design Cl maps El Other ��,�
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes !� go ❑ 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 B'Ro ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes B -No ❑ NA [:INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Elgo_
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[:INA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElL7 Yes
E,5lo
ivo
❑ 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?
El Yes
��,�
L3 ivo
❑ 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
ElE�.Yes
�-�
�o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
"No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
El
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional `Comments andhir Draw,mgs
%
AL
Page 3 of 3 12/28/04

817M.% 2K- $ - IV - 200 7
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:D`7 ArrivalTime: d2: 3 S A4 Departure Time: b3: �4 County: Bl �c Region: "A
Farm Name: Maas- /A9_SS �+/L- ' Owner Email:
Owner Name: Ronk
Mailing Address:
Physical Address:
Facility Contact: Pud 61AJ _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: pp
Integrator: ��tE /��i �, UUJ3z�j. 'j
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [_—] o E:] ` E—] " Longitude: =1 ° ❑ 1 =
Swine
Design Current
Capacity Population
Wet Poultry
Design Carrent Design Current
Capacity Population Cattle Capacity Population
❑ an to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Layer
f ❑ Dairy Cow
❑Wean to Feeder
❑ Non -Layer
' ❑ Dairy Calf
®Feeder to Finish2-
TO I
❑ NE
Dairy Heifer
Y
❑ Farrow to Wean
® No
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder'
❑ Non -Dairy
❑ Farrow to Finish
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ NE
❑ Non -La ers
El Beef Feeder
❑ Boars
❑ NA
❑ Pullets
❑ Beef Brood Co
❑ Yes
-, .
❑ Turkeys
❑ NE
Others
❑ Other
❑ Turkey Poults
❑ Other I
I Num iaer of Structures: EE
Page 1 of 3
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M 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
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
09 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: 09 - z2 Date of Inspection 8 -07-n1
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? ElYes LN 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 A 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 C9 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 [X) 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
V1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
qj No
❑ NA
❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
29 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) 13u - Alk u 14 0.
C C /'4j-'jua
R�
(0,
13. Soil type(s) ,[U4 b LUZ, ore 60/
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(M No
❑ NA
❑ NE
Comments (refer to question #).* Explain any YES answers and/or any recommendations or any other comments
Ilse drawings of facility to_better explain situations. (use additional pages as necessary): x
Reviewer/Inspector Name <; c -V.' ize-y e-1„5 Phone: TO. `1't , 3300
Reviewer/Inspector Signature: Date: J-0-7
Page 2 of 3 12/28/04 Continued

T
wr ;
Facility Number: 041 — Z Z 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 M No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists
❑ Design El Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (9 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
to 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
W 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
[F? 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
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
Pff No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

`4
Type of Visit Qr4eompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 3 : t7 Departure Time:�L� County: Region:
Harm Name: zt , %�r � s ��ir �: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: SQ
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =]o =' =" Longitude: 0° =,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current Design Current
Design Current
Swine
Capacity Population Weft Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
a. Was the conveyance man-made'?
❑ Wean to Feeder
❑ No
❑Non -La er
❑ Dai Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish
�, ,::,
El Dairy Heifer
El Farrow to Wean
�...
DryP °��.try
El Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
ElLayers
Beef Stocker
El Gilts
Non -Layers
❑Beef Feeder
❑ BoarsElPullets
ANo
❑Beef Brood Co
❑ NE
❑ Turkeys
❑ Yes
Other
ID -0 er
a. ❑ Turkey Poults
Ik ❑ Other
Number of Structures:
LL�ml
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection ids
Waste Collection & Treatment
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 IRLNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f �j
Observed Freeboard (in): M
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J4 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 M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 101bs ❑ 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
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
(A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® 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 any recommendations'or anyother comments
Use drawrngs o1 facility to better explain -situations. (use additional pages as necessary,)'r ��.
Reviewer/Inspector Name �,-�-- i Phone: �O O
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection:
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ 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 RNo ❑ NA EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfaIl ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JKjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J 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
®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
0 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
El 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
JKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;RNo
❑ NA
❑ NE
Additional Comntents and/or Drawings:
i
Page 3 of 3 12/28/04

Type of Visit %) 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:10 3i O Arrival Time: Z spm Departure Time: County: (S'1 Region: � -
Farm Name:Owner Email:
Owner Name: R.aqkoNot Ua 0 4 L4 S Phone:
Mailing Address:
1 z
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator: 40 ry-w�._
7
Certified Operator: �Q : w _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=A
=td Longitude: = ° = i =ti
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder i
Feeder to Finish I 5Z 0 O
❑ Farrow to Wean
❑ Farrow to Feeder ;
❑ Farrow to Finish
❑ Gilts
❑ Boars {
Other
❑ Other
❑ Layer
❑ 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?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Design Current
Capacity Population
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 [9 No ❑ NA ❑ NE
❑ Yes
❑ No
[9NA
❑ NE
❑Yes
El No
E] NA
❑NE
6 NA
❑ NE
❑ Yes
❑ No
❑ Yes
N�No
❑ NA
EINE
❑ Yes
j9.No
❑ NA
❑ NE
12128104 Continued

Fllcility Number: 'j — Date of Inspection 14 33 O
Crop types) =w►oA0. _ uK� t�¢,r a dt,a-Z� 5�.�.� a
raw -
�, aw. /
QMAt
Waste Collection & Treatment
13.
``
Soil type(s) Ly.,,c��s.a�► ��r�s�^� t''�.o1a� e."
1-0
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ff No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
XNA
❑ NE
Structure_] Structure 2 Structure 3 Structure 4
Structure 5
❑ NA
Structure 6
Identifier:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ yes
® No
❑ NA
Spillway`.':
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[A No
Designed Freeboard (in):>
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in):
❑ 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.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
E6 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
Lel 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 05 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [RNo [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 Drifl ❑ Application Outside of Area
12.
Crop types) =w►oA0. _ uK� t�¢,r a dt,a-Z� 5�.�.� a
raw -
�, aw. /
QMAt
13.
``
Soil type(s) Ly.,,c��s.a�► ��r�s�^� t''�.o1a� e."
1-0
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
S 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
[A No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
91 No
❑ NA
❑ NE
Gol'A " too) vP c-�S
Reviewer/Inspector Name € -tea Phone:
Reviewer/inspector Signature: Date: O A t}
12/2VO4 Continued

ricility Number: `f - ZZ Date of Inspection V 31 0
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 CAW MP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropirate box. ❑ WUp- ❑ Checklists- ❑ Design- g ❑ Maps, [I Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes [LNo ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysiar ❑ Waste Transfers ❑ Annual Certification"
❑ Rainfalls❑ Stocking' ❑ Crop Yielder ❑ 120 Minute Inspections❑ Monthly and 1" 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
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30_
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
91 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
K) No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did ReviewerlInspector fail to discuss review/inspection with an on-site representative?
ElLK Yes
No
[KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[LNo
❑ NA
❑ NE
ldd�t�onal>�CommetttsaA[Var�Drawiings k h g ° Zia
12/28/04
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 1 10 Date of Visit.: i o Time:
Not Operational Q Below Threshold
(Permitted ELCertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: V4 S S___ County:
Owner Narme:. . �� } � ��� . .. Picone No: _ `,��d — - 8
Mailing Address: - G 24 3
Facility Contact: gpn ^ ---- ---. - ---- -Title: Phone No:
Onsite Representative: .__� w. -:_S Integrator: Crj= 11....
Certified Operator:._ ennuk 1 . Operator Certification Number.
Location of Farm:
$Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' Du
Disclmnues & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 5&No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 5jrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes g No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 51No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ W �....1[.......------
Freeboard (inches):
1282103 Continued

Facility Number: 97— ZZ
Date of Inspection 11 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
& Does any part of the waste management system other than waste structures require maintenancehunprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Fzozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receivingcrops differ with those designated in the Certified Animal Waste Management Plan (CtAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes g(No
❑ Yes 0 No
❑ Yes M No
❑ Yes ® No
❑ Yes J9.No
❑ Yes KNo
❑ Yes &No
❑ Yes JKNo
❑ Yes RNo
❑ Yes JANo
❑ Yes RNo
❑ Yes NkNo
❑ Yes- § No
❑ Yes ❑ No
❑ Yes P[No
❑ Yes 9SNo
❑ Yes JLNo
its {l�tr tf3 Q)$>� ilIIyXF
![S a/Qr atij!P MM_ Ot ilnyby'
c�iyto; A{ sdditaonal 11; �r ❑ Field C ❑ Final Notes a
�.-�i_�`'`=�=-..�..
MW
Reviewer/inspector Namef -' - `•
x T
Reviewer/inspector Signature: Date:
12/12/03 Continued

Facility -Number: Date of Inspection 1...=5=
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
22. Does the facility fail to have al m is of the Certified Animal Waste Management Plan readily available?
W 0-s+e a.�.. t� S; s s IL3�Qif 2 'f
(ie/ WUX, dfecklist�desigh, tc.)
❑Yes
Wo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ff No
E] Waste Application] Freeboar&"❑ Waste Analysk"❑ Soil Samplin§,�
Gam e v"� �' -Za �v c`►,�,� S LZ4 f-'-` 4--- % n� �a �+r b S .
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J,No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
07No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
H
(iet discharge, freeboard problems, over application)
❑ Yes
EjNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
Flo
28. Does facility require a follow-up visit by same agency?
❑ Yes
NkNo
29. Vrze any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
BNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ,$ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JKNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes J.No
33. Did tate facility fail to conduct an annual sludge survey? ❑ Yes H No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ANo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Ayps ❑ No
JaStocking Form KCrop Yield Farm ❑ Rainfah-[] Inspection After 1" R" --
[]
ail❑ 120 Minute Inspection6--❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You wffl receive no fi;rther correspondence about this visit.
`-,- x . ._.. a,.._. . v�M .q ] - xry n-'—y-�'�-�t•F,�—s..... +8Y �, Y" , -'�
QTb3�1nW1IISi y�Ts'�� c avP....y
Y:n •.='X,^.1""..'w.�:A`�:.'4r:{Y%.� L�.'t3"5...���.;=-..-..-�LPf."c. ki.i �.";.'']N'.:.. —' e _1`..-.y-«k'9`--..�
W 0-s+e a.�.. t� S; s s IL3�Qif 2 'f
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L':.�•� y1O� G �v^e�t �S v� i Z3 /aL y C
40 re°LBa 11e- pce' a Se
Gam e v"� �' -Za �v c`►,�,� S LZ4 f-'-` 4--- % n� �a �+r b S .
r, G (vete, 4 U -t i C r. OF 4AIV r%- UPS C,9,� 1( C -A Lr � i e U �
S{� c.�*.�..q � ��}� [ ; � �-�-.�v► s i v. c� - S � •fe r�ca-co�S , !A da
40c- ce-v i s+n3
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I2/I2/03