090035_INSPECTIONS_20171231

Type of Visit: QrCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (3r outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / --/ Arrival Time: Departure Time: L County: Region:
Farm Name: G Owner Email: '—�—
Owner Name: C, Phone:
Mailing Address:
Physical Address:
Facility Contact: a d t tp/ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
/f
Phone:
Integrator:
Certification Number: 179-23'_
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes No ❑NA E] NE
❑ Yes [:]No ❑ NA ❑ NE
❑Yes E] No ❑NA []NE
❑ Yes ❑ No
❑ Yes Q o
❑ Yes Flo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 1/4/7015 Continued
Design
Current
Resign
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry',
Ca'gacity
Pop.
Cat#le �" Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to FeederNon-La
er
Dai Calf
Feeder to Finish
/D
5
Dairy Heifer
Farrow to Wean
Design I'
Current
Dry Cow
Farrow to Feeder
D , Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey Poults
Y
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes No ❑NA E] NE
❑ Yes [:]No ❑ NA ❑ NE
❑Yes E] No ❑NA []NE
❑ Yes ❑ No
❑ Yes Q o
❑ Yes Flo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 1/4/7015 Continued

[Facility Number: jDate of Inspection:
Waste Collection & Treatment
e• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ 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): O�
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 [IJ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA [] NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []<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 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Applieation
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 to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):��a
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
El"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[T] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [r] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 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 2/4/2015 Continued

r lFacility Number: 91- j a Date of Inspection: —/ /
a� 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes o ❑ NA D NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [/] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
Pelf- Y�
❑ Yes [No
Ej Yes Er -No
[—]Yes C3 No
[:]Yes dNo
❑ Yes
❑ Yes
❑ Yes
Ea'No
C3 No
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
-L �"L- 1��-1�� T� 1C; x gyros/,,-Le��I��--/�r� �r
�.� s�----� .�^ r<<s��� �r/�,�n G G,`�7►�--- �>� ��cs -rte I����
Sll7a�L` ��
.dl
'T'pr
Reviewer/Inspector Name:
Reviewer/]nspector Signatut
Page 3 of 3
Phone: 9 a o -D/-�-1
Date: _ /,�9--/-3 -
2/4/2015

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ` Departure Time: fig County: Region:
Farm Name: Owner Email:
Owner Name: l.��V� L Phone:
Mailing Address:
Physical Address:
Facility Contact: kU 111a 01K Title: Phone:
Onsite Representative: Integrator: Pry s
4
Certified Operator: 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 Capaci1. ty Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Nan -La er
Dai Calf
Feeder to Finish p
Dai Heifer
Farrow to Wean
Design
Curren#
D Cow
Farrow to Feeder
D , Poult .:
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -1 a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? ❑ Yes [] No +] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) ❑ Yes ❑ No [P NA ❑ NE
c.What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [RNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes M 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? TT
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 14 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39 y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �9 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 [N 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 Accee table Crop Window Evidence of
Wind Drift ❑ Application utside of Approved Area
t2. Crop Type(s): `" � l qx4t4--A"Zeze�) -,A-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�No
❑ NA
❑ NE
❑Yes{VNo
No
❑NA
0 N
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[—]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [�LNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: jDate of Inspection-
ns ection:24.
24.Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
M No
[:] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant'sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
TT
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 CAWN4P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes M No ❑ NA ❑ NE
❑ Yes � No ❑ NA [:]NE
❑ Yes 14 No ❑ NA ❑ NE
❑Yes MNo DNA ONE
[:]Yes No
❑ Yes No
❑ Yes [� No
❑NA ❑NE
0 N ❑NE
❑NA ❑NE
Phone: 1Y10133 5we
Date: I /
2/42015

r i ype of visit: V uompuance inspecnon tJ uperation Review U Ntructure Evaluation tj t ecnntcat Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:jZ! ./I �llb l Arrival Time: Departure Time: County: 81 -ft G4%) Region
Farm Name: Owner Email:
Owner Name: 5 ,. -� LJ•- 3 a 5 L Phone:
T -
Mailing Address:
Physical Address:
Facility Contact: phV I'd 1�p. o r Title: Phone:
Onsite Representative: Integrator: r ie' �
Certified Operator: ti Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poaltry
Capacity
Pop.
Cattle Cagacity Pog.
to Finish
La er
Dairy Cow
Wean to Feeder
luWean
Non -La er
Dairy Calf
Feeder to Finish q 9
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul
Ea ace
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Points
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CANo ❑ NA ❑ NE
❑ Yes ❑ No §0 NA ❑ NE
❑ Yes ❑ No [P NA ❑ NE
❑ Yes ❑ No
❑ Yes 50 No
❑ Yes fR No
�] NA ❑ NE
T❑NA ❑NE
0 N ❑NE
Page 1 of 3 2/412015 Continued

Ifacility Number: t7 - Date of Inspection: j 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P 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 9@ No D NA ❑ NE
maintenance or improvement?
Waste Aonsication
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. ❑ YesLP
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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. Soil Type(s): 44�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[)a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfail ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [s] No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perrriO
❑ Yes
M No
F] NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W No
[] NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
E]NA
E]NE
❑ Non-compliant sludge levels in any lagoon
E]Yes
P No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
CQ No
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
P No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ® No C3 NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
� No
E] NA
[,] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CpNo
E]NA
E]NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
E]Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
CQ No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9i4 - 33 Ov
Date: /
21412015

type of visit: W c:ompuance inspection tJ operation tceview V structure Lva[uation V i ecanicat Assistance
Reason for Visit: 46 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:al. Departure Time: Z.' County: Region:
(SarjCFarm Name: r "� M� Owner Email:
Owner Name: 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: cj(-.PMQS Title: Phone:
Onsite Representative: V Integrator:
Certified Operator: �t„JI, 1; Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P
No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No JR] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 0] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 21412014 Continued
Design Curr ut.Y
Design
Curren#
Design Current
Capacity Pap.....-. ;
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
PBW�e
Finish'''
La er
Da' Caw
Feeder
Non -La er
Da' Calf
Feeder to Finish
Q
y
Da' Heifer
Farrow to Wean
Design
Curren#
D Cow
Farrow to Feeder D . Poul Ca 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
10ther
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P
No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No JR] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 0] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 21412014 Continued

Facili�gNumber:- Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Struc e 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
DgNo ❑NA ❑NE
❑ No Rg NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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
P No
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
❑ Yes
No
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
[P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce ble Cop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ir"
13. Soil Type(s): __
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
['� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes $9 No ❑ NA ❑ NE
❑ Yes
[!IpNo
❑ NA
❑ NE
❑ Yes
P No
DNA
❑ NE
❑ WUP ❑Checklists ❑ Design [-]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Qn No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA Q NE
Page 2 of 3 2/4/2014 Continued

1Eacilit}Wumber; Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? C—] Yes ['$ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below. r
❑ 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes® No
❑ NA ❑ NE
E] NA 0 N
E] NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fp No
C] NA
E] NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P No
[3 NA
[:]NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[]Yes
f) -&No
❑ NA
❑ NE
permit? (i.e., discharge, fteeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
W No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
f7] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer.to question#)eEzplamianyaYES auswers and/or.any additroaaldreeonimeudations or any othe6i.ommeitts
Use drawings of fidlity to better-,eapla�a; s�tvations (useradditional pages as necessary}: MFln
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /R3-33aa
Date: LIZ 7 j
2/4/2014

type of visit: * Uomptnance inspection U Uperatton mevlew U btrueture Evaluation U tecmmcal Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:2 Arrival Time: 3:Qo Departure Time: o ; OD County: LADFnI Region: Fid
Farm Name: ,2405 S[�.{-� Cic ' t Owner Email:
Owner Name: 9CW! " S j LLL L - Phone:
Mailing Address:
Physical Address: J
Facility Contact: Y"1C-Wj Title: Phone:
Onsite Representative: t-a"Jo Integrator:
Certified Operator: I ` 10U%AC
"' �U'L .VYt Certification Number: ����7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
:,Design .
,Current
Design Current
Swine Capacity Pop.
WnProtryCac ty
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
a. Was the conveyance man-made?
Dairy Cow
Wean to Feeder
Non -La er
❑ NE
Dairy Calf
Feeder to Finish
❑ No
NA
Da' Heifer
Farrow to Wean
.,.:
Des].
Cow
Farrow to Feeder
D , P,oul CpaciP,o
❑ Yes
Non -Dairy
Farrow to Finish
Layers
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
Beef Stocker
Gilts
Non -Layers
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Beef Feeder
Boars
Pullets
of the State other than from a discharge?
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Irnmacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
`P No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

[Facility Number: - Date of Inspection: Y/7-7112—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No jy�j 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 P 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? T
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 [P 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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EP 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 rC op Window j ❑ Evidence of
Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �S`W C�'r1'>+ gz �$S �r 4 1 �� . co_y -�/ �7
'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ep No
`[
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
E] Yes
] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[D No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[p No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [5 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ "O] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/417011 Continued

a Facili' Number: - Date of Inspection: 9 12,411
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes � No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CpNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[P 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
[)9 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Rg Yes
g&No
❑ NA
❑ NE
yyApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M 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
O No
❑ NA
❑ NE
Comments (refer to question #): Eaplain.anyYES answers'and/or'any additional recommendations or any other comments
Use drawings of facility4o better eaplainaituations (use addjtib ai .pages"as necessary)`
Reviewer/inspector Name: rTU'� "`a l° Phone: / X0 3 -33CP
Reviewer/Inspector Signature: ��44 _ Date: /lo? -17Z
Page 3 of 3 11412011

It ype of visit: W Uomptiance inspection V uperation Review V structure Evaivation V recnmcat Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Lill
Farm Name:?—
Owner
ame:?
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: .QQ County Rd Region: CPO
Owner Email:
Phone:
�r-
Facility Contact: Title: Phone: j
Onsite Representative: poeS L (k,`o integrator: �eSTCt
Certified Operator: tet/ [ Ir•pc„� Certification Number: [ 9O 5?)
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
0 No
Design
Current
Design C+nrrent
Pr7-Swine
Capacity Pop.
Wet Pointy
Capacity
Pop.
Castle Capacity Pop.
Wean to Finish
U�PNA
La er
Non -La er
Design
Current
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Wean to Feeder
Feeder to Finish 4 r
Farrow to Wean
Farrow to FeederDr
Poul
Ca acs
P,o
Non -Dairy
Farrow to Finish
® NA
Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Beef Stocker
❑ NA
Gilts
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Non -La ers
[E])No
❑ NA
Beef Feeder
Boars
Pullets
Beef $rood Cow
Turke s
„
Other
Turke Poults
LF OtherM
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
U�PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Eg No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[E])No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

>Facili Number: q- Date of Insj! fJj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E) No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
1
�L'11Sf
-
0 NA ❑ NE
e NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
18. Is there a lack of properly operating waste application equipment?
Uany 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
ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
® No
Waste Application
❑ NE
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [0 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 Area
/ ,,o�f�Approved
12. Crop TYpe(s): �� i7?UdQ C�✓a gS (!!'` L 3 6 e4 In IJC.[=l�G
13. Soil Type(s): I�AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - 3 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]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
Commnts'' refer to uestion . -Emlain _ay: YEStanswers-and/or any. additional- recommendatiom or any. other comments:= -'4
.:
Use drawings of facility to better, a lain
situations use additional pages as necessary
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ER314o ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
M Yes ❑ No ❑ NA ❑ NE
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: '310-Y33-3300
Date: i aqll�
2/4/2014

lype of visit: W Compliance inspection V Vperation Review O Structure Evaluation U echmcal Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit. D ( Arrival Time: Departure Time: County: aww
Farm Name: 1 Q � C4 ALLC. Owner Email:
Owner Name: .5%.ul? 6 Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ,& Title: Phone:
Onsite Representative: �Ctyb(�s LQm—lo _ Integrator: fres_ ae
Certified Operator: Wil f 4%_ Llsljka#4^ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ NE
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D Poul
Ca acity
P,o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
C] NE
[:]Yes
❑No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
C] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page l of 3 2/4/2011 Continued

Facft Number: - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2
Identifier:
Spillway?:
Structure 3 Structure 4 Structure 5
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
No ❑ NA ❑ NE
No Pit NA ❑ NE
Structure 6
[] Yes P No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes EP No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA 0 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 [3 Application Outside of Approved Area
12. Crop Type(s): t_ "�`""Q � �r 9Vt,__
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E4 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
Pg 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 ❑ YesNo ❑ NA ❑ NE
the appropriate box. EP
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1I 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 �j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number_ - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i -e., discharge, freeboard problems, over -application)
Yes
� No
E] NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes r] No ❑ NA ❑ NE
[3 Yes P] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes
LpApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
❑ NE
No
❑ NA
❑ NE
EpNo
❑ NA
❑ NE
M No
❑ NA
❑ NE
Comments (refer to question #) _Explain any YES answers and/or any additional recommendations or any, othercor '#s.
Use drawings of facility to better explain situations (use additional pages as necessary)::;.
reg e -o -ed 9-1q-1�.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 5%0-V33 3300
Date:
2/4/2011

I
Type of Visit * Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: d Arrival Time: Departure Time: 6 -County: Region:
Farm Name: OU c4T., LLcr Owner Email:
Owner Nnmi � %3&-rT a� 14LLCI PhnnP!
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `, ��� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = n =I
=" Longitude: =0[=i = "
Discharees & Stream Impacts
1. Is any discharge observed from any pari of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
F NA
❑ NE
Design]NEEnrrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity PopulationCattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
� No
❑ Dairy Heifer
❑ Farrow to Wean
Dry PoultryDryCow
❑ Farrow to Feeder
C1Non-Dairy
❑ Farrow to Finish
11La Layers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
[I Turkeys
Other
0-10
❑ Turkey Poults
❑ Other
Number of Structures
er
Discharees & Stream Impacts
1. Is any discharge observed from any pari of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
F NA
❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
❑ No
JS NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
12/28/04 Continued

17aciliy Number: - Date of Inspection I ( 1 r11D1 U�
��
❑ Yes
rim
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
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
?N
❑ No
P NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ Yes
U3)No
❑'NA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
MNo
❑ 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
T Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[WN.
❑ 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
�Vo
El NA E] NE
maintenance or improvement?
`
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
F No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% 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
rim
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U3)No
❑'NA
❑ NE
CommentsIN 11
rCfcr 6 uestion #1) Explain an YESkanswers and/ ran `recommendah ns or a other come 1
g tY p _.. menu
( q i Y use addttiaA[l a es as necess
_.
-Use drawm sof faciii tobetter ex lain situattons ( p g ar'J'
I rY{
Reviewer/inspector Name :.,.: Phone: 3
Reviewer/Inspector Signature: Date: qD Q
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 [41 No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes r
No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Outer Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Wo
[INA
[:1NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
( No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
ll
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
Page 3 of 3 12128104

Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency O Other �n J❑ Denied Access
Date of Visit: I q1310qArrival Time: -%k Departure Time: �f 4— County: V Region:
Farm Name: LLC' 2 T 0 5' Owner Email:
Owner Name: Jl�if-� rl Phone:
Mailing Address:
Physical Address:
Facility Contact: F`► Title: Phone No:
Onsite Representative: �tYIRQsYJ integrator: -
Certified Operator: Tarn fe— :1(1llS Operator Certification Number: qg .,z
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [=] e 0' =] Longitude: =o =' 0 u
—5=C5 ent
Swine Capacity Population
❑ NE
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Yes ❑ No NA
❑ Wean to Finish
❑ Layer
-
❑ Yes � No ElNA
❑ Da Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish .3/3
Lj Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
- ❑Gilts
❑ Boars
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
❑Beef Brood Cowl
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes 11 No ❑ NA
❑ NE
❑ Yes � No ElNA
[__1NE
12128104 Continued

Facility Number: — hate of Inspection
❑ Yes
C�aigo
Waste Collection & Treatment
El NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1P No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ NoNA ❑ NE
Stnic IT 1 Structure 2 Structure ? Structure 4
Structure
q.ucture G
Ide�ttifier:
❑ Yes
V�
Spillway?:
El NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
:Z0
❑ NA
Observed Freeboard (iny
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes(�j
No El NA El NE
r
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes�No
El NA El 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
S. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
No El NA [D NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[] No El NA EJ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/imp'rovement?
11, is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Crop WindowEvidence of Wind Drift ❑ Application Outside
❑ Outside of Acceptable Crop
of Area
10
G �mJq C1 ��'1- VYr lI L"y'5V
12. Crop type(s) �Ud q5
13. Soil type(s) �Y�Q,I]s✓i ��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C�aigo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
N
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
C] Yes
;No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V�
[:1 NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
:Z0
❑ NA
❑ NE
Comments (refer to question t): 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):
r
Reviewer/inspector Name Phone: .3 r
Reviewer/Inspector Signature: Date:
Il/lU/U4 Gonunuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesN ❑ NA [_1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA ❑ NE
the appropirate box.
Other Issues
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
,
28.
2l.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather
Code
ENo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
hfo
❑ NA
❑ NE
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[k—(Tqo
❑ NA
❑ NE
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
d o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El yes
YNo
❑ NA
❑ NE
Other Issues
_
,
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
H,
24.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[9/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ltd No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[O No
❑ NA
❑ NE
Additional Comments andl6r Drawings r
_
,
H,
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 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: %e-` County: WrD PJ Region: oq2_
I
Farm Name: Sw� - LLC _ Owner Email:
Owner Name: S�-� �w S ac Phone:
Mailing Address:
Physical Address:
Facility Contact•Title: Phone No:
Onsite Representative:Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =I=" Longiitude: ❑ o ❑ g ❑ 1i
Design
S..wtne f Capacity
s Curve t Design Current
Pop�ulahon Wet Poultry Capacity Papulation
Design Current
Cattle Capacity Population
❑ NA
❑ Wean to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Yes
IEJ Non -Layer I
Dairy Calf
❑ NE
Feeder to Finish 4LQ
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean=
❑ NE
❑ D Cow
❑ Farrow to Feeder
Dr;y Poultry
El Layers
❑ Non -Dairy
Ni ❑Farrow to Finish
❑Non -Layers
❑ Beef Stocker
❑Gilts
❑ Pullets
❑ Beef Feeder
❑ Boars
-------------
Turks
10 Beef Brood Co
Other s' k A
ElTurkey Po ults
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ OtherE]
A;
❑Other
Number ofsStnuctures:
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
INA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
bNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(91No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)9 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

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 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F3 No ❑ NA EINE
(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 o El NA [INE
maintenance or improvement? I
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No Cl NA ❑ NE
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ElNA ElNE
ElExcessive Ponding F-1HydraulicOverload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.) /
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type{s}
151
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes yo El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I/ No El [:1NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �9No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WVo ❑ NA ❑ NE
.. - ..• »a t �:.. .. hiss ---�� t - 7u�X ^:` `;5 .
Comments {refer to �gaesti6 i #): Explain any YES answers and/or any recommendat,ons or any other comments .
Use drawings of facility,to better explain situations. [use addtteonal+pagesfas necessary)
Re-dewer/Inspector Name m ' -- Phone: (9 10) C(33 _33eW
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued
Facility Number: — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes KNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [:]No
ANA
[:INE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes P9 No
[--INA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F3 No ❑ NA EINE
(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 o El NA [INE
maintenance or improvement? I
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No Cl NA ❑ NE
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ElNA ElNE
ElExcessive Ponding F-1HydraulicOverload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.) /
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type{s}
151
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes yo El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I/ No El [:1NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �9No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WVo ❑ NA ❑ NE
.. - ..• »a t �:.. .. hiss ---�� t - 7u�X ^:` `;5 .
Comments {refer to �gaesti6 i #): Explain any YES answers and/or any recommendat,ons or any other comments .
Use drawings of facility,to better explain situations. [use addtteonal+pagesfas necessary)
Re-dewer/Inspector Name m ' -- Phone: (9 10) C(33 _33eW
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: = Date of Inspection
Reouired 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 30 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi ((
gn El El
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
F10
❑ NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:1 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
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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 Reviewerhnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Commegts and/orDrarwrngs µ f�
r�;` " *s
MI
Page 3 of 3 12/28/04

Division of Water Quality
" Facility Number D Q Division of Soil and Water Conservation
JI O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visi-tRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `f� iil Departure Time: =�i County:
Farm Name: _ � V� �� C;,A � _ 4Vo V i5 Owner Email:
Clvuner Name: ���� CA � �C� _ �� PhnnP:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = o ❑ I u Longitude: E1 ° = ' E --]-
Design.
W
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
i❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish 14410 O�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current .
Capacity. Popiilation
p
❑ Daig Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl I
c. What is the estimated volume that reached waters of the State (gallons)?
is
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 pan 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 Wto ❑ NA ❑ NE
❑ Yes
❑ No
ENA
❑ NE
❑ Yes
ElNo
IgNA
❑ NE
❑ Yes
❑ No
qj NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
UjNo
❑ NA
❑ NE
12128/04 Continued
J

Facility Number`_K�� Date of Inspection
Waste Collection & Treatment
Reviewer/inspector Signatur ill Date:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ip No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
IRNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
ElNA
ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
C
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rft No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes�No
El NA
El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f� 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) ✓ M —+ _ s (/ t)L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[–] Yes [19 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name C KTrC>J J Phone: 3 3&P
Reviewer/inspector Signatur ill Date:
1 12/28/0' Continued

Facility Number: C)9 Z3 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ W ­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [:INA ❑ 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 V No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ YesNo
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
K►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
T No
❑ NA
❑ NE
12/28/04
E

Type of Visit '19��ommpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Adoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: '�D Departure Time: 1 f i30Ctrn, County: 1--, Region:
Farm Name: SkYl , 424 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ry
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F-1 e = = u Longitude: =10=1 ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current ; Design Current
Design Current
Swine
Capacity Popuiatioti ` ` Wet Poultry Capacity Population
Cattle Capacity Popufation
❑Wean to Finish
[17L aTr
iry Cow
❑ an to Feeder
P 10 Non-Laye I
iry Calf
Feeder to Finish
t[ U
❑ Dairy Heifer
Farrow to Wean
I,
=rPoultry
El D Cow
❑ Farrow to FeederEl
' A
❑
LaersFarrow
Non -Dairy
❑to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co wi
2. Is there evidence of a past discharge from any part of the operation?
-- . El Turkeys
❑ Turkey Poults
No
❑ Other
❑ Other
Number of Structures:
❑ Yes
No
❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ 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
f NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: —
Waste Collection & Treatment
Date of inspection ID'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�l No
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LID
5.
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?
❑ NA ❑ NE
[?PNA ❑ NE
Structure 6
❑ Yes [P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ff No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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
EANo ❑ NA
❑ NE
Reviewerllnspector Signature: Date:
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) M-I&J4v
13.
Soil type(s) Q
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
P No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
10No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
l
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
i� No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #):; Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additionspagesFas necessary).:
Reviewer/Inspector Name p Phone: 3
Reviewerllnspector Signature: Date:
Page 2 of.$ 112/28/04 (:onnnued

Facility Number: oct— Date of Inspection Ib'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ( No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ maps p El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
" No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
?9 No
[I NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
01 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?
❑ YesNo
ElNA
[:1NE
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
CtNo
❑ 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
�9No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: .�G �^ Arrival Time: Q= Departure Time: County: Q l aaieu Region: F1Ro
Farm Name: 5 k• f- C;ty }-li o 4 s _ i_ L C Owner Email:
Owner Name: I)2Q u C. N 4t x, Phone: _ 9 ty - SG a - �Tl�
Mailing Address: 8 n 5'3.0 F,/�ra�c7 fow&I. A C. o? 33
Physical Address:
Facility Contact: n / Title: nPhone No:
Onsite Representative: � . d1.. Bex �' I a+•-•'• e 1�e� Integrator: P"CAf_ea I e__
Certified Operator: Operator Certification Number: g 7_24-3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =I=" Longitude: =o='
o❑' ❑ 1f
Design CurrentsDesign Current t r1FMWDes�ign Current
Swine Capacity Population «'et Poultry Capacity Poptlatton Cattle R� Capacity 'Population
❑ Wean to Finish ❑ Layer El Dairy Cow
❑ Wean to Feeder ❑ Non -La ei ❑ Dairy Calf
Y, ® Feeder to Finish I 14q[D 1 ? 3a0 ': ❑ Dairy Heife!
❑ Farrow to Wean Dry Poultry �� ❑ Dry Cow
❑ Farrow to Feeder
❑ La ers ❑ -Dairy
❑ Farrow to Finish El Beef Stocket
FGilts Non -Layers
El Pullets ❑ Beef Feeder
Boars ❑Beef Brood Cow
❑ Turkeys -
Other ❑ Turkey Pouts
❑ Other ❑ Other Npmberoi�Struetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
14 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[d No
❑ NA
EINE
other than from a discharge?
12/28/04
Continued

F ."A
Facility Number: y` — 3S' Date of Inspection I Vow/0r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [jfl No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in): 4-^t3
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [)-d 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 [M No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
© 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
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s) Xe )9
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
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
, ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[0 No
❑ NA ❑ NE
7— Toy to C %1,.LJill. Q VGgG-+aT'IV Gov C3 `c�r4� lade %P Qbl=
S po-t s .
Pull plf's 0.rG Ita.kif%1 .. KGpai�
Reviewer/Inspector Name Z o+. " ' %'` ,., a rig Phone: fix' r l
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: 4 — &&7 Date of Inspection as—
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EZ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
- ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
}�
M 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
[9 No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
09 No
❑ NA
❑ NE
A�ddrtionalICo ments�and/or`brawings�; y{sLe
12/2$/04
12/2$/04