090054_INSPECTIONS_20171231

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: i w- County: t3 Region:
Farm Name: �>�QI`Y�) R-�5 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �i�rn�5 Title:
Onsite Representative:
Phone:
Integrator: PPre26�
k..Z
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
Z. 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 �TNo
❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
❑ Yes [:]No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued
Design Gnrrent
Design.
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Gap c ty
Pop.
Cattle Capacity Pop.
t
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
D
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P.oul
Ca ac'
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other"
TurkeyPoints
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
Z. 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 �TNo
❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
❑ Yes [:]No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *o ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes TT❑] No J NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo E]NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? Ej 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 E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA [3 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] YesNo E]NA
❑ Excessive Ponding [:]Hydraulic Overload [:]Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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 al components of the CAWMP readily available? If yes, check
the appropriate box.
❑Yes No E] NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑Yes
�No
❑NA
[]NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
P No
[:INA
[] NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ NA [:]NE
❑ Waste Application ❑ Weekly Freeboard L]Waste Analysis [:]Soil Analysis ❑Waste Tr sfers ❑ Weather Code
❑ Rainfall ❑Stocking; [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: IDateof Inspection: 6211-117
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
21 is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
Comments (refer to question #) Explain any,;YES answers and/or any additional recommendations or any other comments. ;
Ilse drawings of facility to better explain situations (ase additional pages as necessary),
Reviewer/Inspector Name: �ObL_ tn6�'191'e Phone: j9 3?zV
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

Ii ype or visit: w t ompnance inspection v uperanon xeview v structure r vaivation v i ecumcai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:I 6q" County: County: PL•1 Region:
Farm Name:_ �i1rr 'la.irh �t�,/ �'^ Owner Email:
Owner Name: Pis Tom' MS Phone:
Mailing Address:
Physical Address:
Facility Contact: �fq MAS /_ Title:
if
Onsite Representative:
P'
f /
Certified Operator:
Back-up Operator:
Integrator:
Phone:
Certification Number: 2_ZVba
Certification Number:
Location of Farm: Latitude: Longitude:
�= 1)estgn Current
❑ No
Design Current
Design Current
Swine Pop.Wet
Poultry ,
Capacity Pop.
Cattle Capacity Pop.
fi,Capacity
n No
..
❑ NE
can to Finish
La er
Da Cow
can to Feeder
on -Layer
Da' Calf
eeder to Finish
° .+
'-
Da' Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D , Poul
Ca aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
L Beef Broad Cow
Boars
_,.
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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 �g No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
[:]Yes
❑ No
1� 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?
[D Yes
❑ No
� NA
❑ NE
[:]Yes
E] No
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Numbtr: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4
Structure 5 Structure 6
❑ NE
❑ NE
Observed Freeboard (in):a
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
R
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 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 ❑ YesNo [—]NA E]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 > l0% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop (Window ❑ E
vidence ind1Drift AppI' on Outside of Approved Area
12. Crop Type{s}: � S 1 J,4'it' m+Li G�Q R^? / 1 sG� � ' J M t
13. Soil Type(s):
14. Do the receiving crops differ fromkhose designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
l6. 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?
❑ Yes
[p No
[] NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [� No [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Re uired 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[E1 No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

MF
Facili Numbler: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MA 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
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below_
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 ® No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 9, 3o) lb
2/4/2011

(Type of Visit: 4P Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: Departure Time: County:X Region:
Farm Name: err Y4! Owner Email:
Owner Name: f`Q Phone:
Mailing Address:
Physical Address:
Facility Contact: ;n. S I&J, Title: Phone:
Onsite Representative: u Integrator:Fte-5
Certified Operator: , yr 1V Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry ,
^:_gre,apacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
a. Was the conveyance man-made?
Dairy Cow
Wean to Feeder
I
INon-LaXer
b. Did the discharge reach waters of the State? (lf ycs, notify DWR)
❑ Yes
❑ No
Dairy Calf
Feeder to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Heifer
Farrow to WeanDesign
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
Current
Cow
Farrow to Feeder
D , P.ouIt .Ca
aci
P,o .
Non -Dairy
Farrow to Finish
Layers
❑ Yes
TT§No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer w
Turkey Poults
Other
Other
Discharges 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
NA
❑ NE
b. Did the discharge reach waters of the State? (lf ycs, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
TT§No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Fac' ' Number: - Date of inspection: 2,3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K] 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): Z� !
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes §aNo ❑ 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?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement? tp
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1p No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VM No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window , ❑ Evidegge of Wind Drift ❑ Application Outside of Approved Area _
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ
from those designated in the CAWMP?
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?
❑ Yes QM No ❑ NA
❑ Yes P] No ❑ NA
[-]Yes
No
❑ NA
❑ Yes
No
❑ NA
❑ Yes
No
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R 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 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 2/4/2014 Continued

aciG Number: - Date of Ins ection: 2
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
Q No
❑ NA ❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q9 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
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `���3'3IED
Date: 47_511,c-
214,1014

I ype of visit: ® Compliance inspection V operation Keview V Structure Evaluation V t ectlnical Assistance
Reason for Visit: *Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:3 /3 Arrival Time: DrfD Departure Time: d.... County:
Farm Name: C--1�(,L 1'`(� CO -I IS Owner Email:
Owner Name: ',�tr(%A L C� �C4�` YY\ Phone:
Mailing Address:
Region:RD
Physical Address: 1
Facility Contact: Title: s 1�0.t�� Title: Phone:
Onsite Representative: _11�r� 5 lam. �4� _ integrator: t✓
Certified Operator:
Back-up Operator:
Certification Number: 1'
Certification Number: rrj 1
Location of Farm: Latitude: Longitude:
Design-• Current
Design
Current
DesignCurrent
Swine Capacity: Pop.
Wet Poultry
Capacity
Pop.
Cattle .. Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
" - —
Dairy Heifer
Farrow to Wean
Design'
Current
Dry Cow
Farrow to Feeder
D , P,ouIt , T
Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
W.
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
NA ❑ NE
BNA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ENA [:]NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

' Faceli Number: JDate of Ins ection: l 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D 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): 3u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Eg� 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
E�j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
t�+ No
[DNA
❑ NE
❑ Excessive Ponding p Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ
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?
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes g3 No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes fg 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 f9 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 fo No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ED No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facih Number: JDate of Inspection: g
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P 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 FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZrNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E3Yes g No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes E3 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ,E3 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P3 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ga No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes ,® No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinzs of facility to better explain situations (use additional Dazes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1
1/412014

Itype of visit: ® Uomptiance inspection V operation Review U btructure Evaluation U f ecttnical Assistance I
Reason for Visit: • Routine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Leh 1 Arrival Time: y., Departure Time: p' County: Region:WII
Farm Name: iy]r115 Owner Email:
Owner Name:L• �]�-,� �GGiNi Phone:
Mailing Address:
Physical Address:
Facility Contact: rv" TJ�LCZ4;01� Title: Phone:
Onsite Representative: <31n4S �o Integrator:
Certified Operator: 5. �. l f Q[� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
„...
DesIg urre-MEM
:.
Design
Current
Design Current
Swifse Capacity Pop.
WetI'otiltry
Capacity
Pop.
Cattle Capacity Pop.
Wesum
an to Finish
La er
Daia Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
-
Daily Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Poul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
-
Other ONES
Turkey Poults
Other
.3
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes 5 No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑No
KNA ❑NE
NA ❑ NE
IFJ
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 tA 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 3 214/2011 Continued

F
lFacility Number: Date of Inspection: too r112—
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
0 No ❑ NA ❑ NE
❑ No OYNA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-9 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes r� No E] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N No [D 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 ofAcceptableCrop Window (( ❑ Evidence of Wind Drift ❑ Application Outside
//of��Approved Area
12. Crop Type(s): �5� �Pxrn�taA C " �+, ) I �N�� C-'- , k nlaagua
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
C] 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 Cp
T 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 `- No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [p No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Condnued

Facility Number: - Date of Inspection: D I
Z
[] No
❑ NA
24. Did the facility fait 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.
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Efl No
❑ NA
❑ Non-compliant sludge levels in any lagoon
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[V No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Q0 Yes
[] No
❑ NA
❑ NE
to Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Efl No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pap -es as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
zlil
Z
2/4/2011

Iype of visit: W uompliance inspection U Operation Keview U Structure Evaluation U Ieennical Assistance
Reason for Visit: a Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �`OD County: SCJ+C)JFN Region:
Farm Name: Gra.j�tai-n rm S Owner Email:
Owner Name: _`e rr%j L. G ,xL .. Phone:
Mailing Address:
Physical Address:
Facility Contact: Van4 Title: Phone:
Onsite Representative: Yi�QS Lf.Lyy�b Integrator: �$
Certified Operator: • �� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
F71ZL
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3- Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
Design Current
Design Current Design Current
E]NA
Swine ' • Capacity Pop p
Wet PoulWY4�. &Capacity Pop. Cat#le Capacity Pop.
Wo
Wean to Finish
Layer Dai Cow
Non -Layer Dai Calf
Wean to Feeder
Feeder to Finish
+* fi�`n'` Dai Heifer
Design -Current D Cow
Dry l o [It ' Ca aci P,o . Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars Pullets
Beef Brood Cow
(?titer - - ,ti Turkey Points
Other 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3- Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes ❑No NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑Yes
(PNo
E]NA
❑NE
[—]Yes
Wo
❑ NA
❑ NE
Page I of 3 214/2011 Continued

Facility ;_umber: 9 - Date of inspection:
[P No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
P No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V�PNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
CP 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 health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rp No
E] NA
E] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
��
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V] 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 E] Application Outside of Approved Area
12. Crop Type(s): 0"t permwt 1 s66), fie5 P t- a l l t S., 0"od
13. Soil Type(s):
hc� b
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
[P No
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
[] NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ 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
❑ 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 [P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [J NE
Page 2 of 3 2/4/.2011 Continued

Facility dumber: - o= jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rn No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes [9 No ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey El 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 $j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes V) No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5D No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M No
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Ofice of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
11 No
❑ NA
❑ NE
® Application Field ElLagoon/Storage Pond ❑ Other:
—4;pp
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes V) 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 5D No
❑ NA
❑ NE
Comments (refer to question #>): Explain any YES -answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
Recey45 rel Ie A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /O – 7
Date: ! Z9
214/2011

►i
e
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 f=ollow up 0 Referral C) Emergency 0 Other ❑ Denied Access
J
I I- - DRe ton: ��
Date of Visit: D Arrival Time: Q Departure Time: �.— County: g
Farm Name:
Owner Name:
Mailing Address:
Lt
Physical Address:
Facility Contact: Title:
Onsite Representative: _� 1A111
Certified Operator: 5, e, 1?_' I
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: --
Back-up Certification Number:
Location of Farm: Latitude: E10
='=u Longitude: = o =I
= u
Design Current
Design Current
Design Current
❑ NE
Swine Capra ty Popglatinn
.Wet Poultry Capacity Papulation
Cattle Capacity Population
❑ NE
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ NE
❑ Yes
❑ Wean to Feeder
10 Non -Layer
1
❑ NA
❑ Dairy Calf
❑ Yes
No
Feeder to Finish s
❑ NE
❑ Dairy Heifer
El Farrow to Wean
Dry PoultryjJ JI'M
❑ Dry Cow
❑ Farrow to Feeder
-
❑ La ers
❑ Non -Dai
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
�
❑ Turkeys
Other _
❑ Turkey Poults
❑ Other
El Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 11No ❑ NA ❑ NE
F-1 Yes
❑ No
[� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: —CJ, I Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [RNA ❑ NE
St7retuI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: - -
Spillway?:
Designed Freeboard (in):
f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
hNo
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
FNo
❑ NA [:INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Wo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
RNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the 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
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any,other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
resc`ewe� '7128 >or
7
Reviewer/Inspector Name Phone: 3aD
ReviewerAnspector Signature: Date:
Page 2 of 3 12b8104 Continued

Facility Number: — Date of Inspection
Restuired 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑ Other
21_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ NA ElNE
ElWaste Application ❑ Weekly Freeboard ElWaste Analysis E]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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[V 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
R No
❑ NA
EINE
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 ReviewerlInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ©-'fes County: L-Ff`� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
1/11
Onsite Representative: Integrator:f�7
Certified Operator: �' Operator Certification Number: ����s�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =I
= 11 Longitude: = ° =' [--] "
Design Current
Design Current
EONo
Design Current
Swine Capacity Papulation
«'et Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ La er I
❑ Dairy Cow
a. Was the conveyance man-made?
❑ an to Feeder
10 Non -Layer I I
❑ Dairy Calf
❑ NE
Feeder to Finish 9940
❑ Yes
❑ Dairy Heifer
NA
❑ Farrow to Wean
Dry Poultr3
❑ Dry Cow
❑ Farrow to Feeder
[:1 Non -Dairy
❑ Yes
El Farrow to Finish
❑ Layers
❑ Beef Stocker
2. Is there evidence of a past discharge from any pan of the operation?
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ NE
❑ Boars
❑ Pullets
ElBeef Brood Cow
❑ NA
❑ NE
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures_ ID
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EONo
❑ 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
99 NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
E8 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ED No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
❑ Yes
[FNo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Lpf rANo❑
NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
INA ❑ NE
Struc ure I Stnicture 2 Stnicture 3 Structure 4
Structure
❑ NE
Structure 6
Identifier:
(a No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
ONo
❑ 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
[PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes�No
El NA EJ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Appligtion Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designateain the CAWMP?
❑ Yes
[FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
(� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(a No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. r
Use drawings of facility to better explain situations. (use additional pages as necessary): t
Reviewerfinspector NameYd�kc±Phone:
Reviewer/inspector Signature: Date:
12/ZRl" Continued

r
• Facility Number: Date of Inspection
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,[Z, No ❑ NA El NE
El 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 [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 [q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ;9 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[8 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
f3No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q) No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 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
q 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
EANo
❑ NA
❑ NE
Page 3 of 3 12/28/04
E

Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit -
Farm Name:
Arrival Time: - a�+ Departure Time: I 91304A I County:
m S Owner Email:
Owner Name: T�+�l L'Qb►-�
Mailing Address:
Physical Address:
Facility Contact: l�� *moi lV� - Title:
Onsite Representative: Aame_<' Lk"
Certified Operator:
Back-up Operator:
Phone:
S LAPW
Phone No:
Integrator: _ heS7ci�
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ e =1
="
Longitude: =0=1 = "
� Desighm,lq t Oren#
❑ Yes
Design Current'
Design Current
Swine £Capacity PopWation
Wet Poultry
Capacity Population- Cattle
Capacity Popalatian
a. Was the conveyance man-made?
❑ Yes
❑ Wean to Finish
❑ La er
❑ Dairy Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[] Wean to Feeder
❑Non -La er
❑ Dairy Calf
[:1 NE
Feeder to Finish❑Dai
...
Heifer
Farrow to Wean
D� PoU
❑ Dry Cow
❑ No
❑ Farrow to Feeder
��� - -
❑Non -Dairy
El Yes
ElFarrow to Finish
❑ Layers
❑ Beef Stocker
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Gilts
❑ Non -Layers
❑Beef Feeder
[:1 NE
EBoars
El Pullets
❑ Beef Brood Co
❑ Turkeys
12/28104
Continued
Other x "
❑ Turkey Poults
_ ....vim , e _ r_-
❑ Other
❑ Other
Number of SEructures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
F] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
N NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
PINA
fr
[:1 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?
El Yes
P No
/
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
El NA
[:1 NE
other than from a discharge?
Page 1 of 3
12/28104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �l
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo
pa
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA [I NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
IR No
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
Y] No
[INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
9� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
Ot No
4. Does any part of the waste management system other than the waste structures require ❑ Yes
P No
❑ NA ❑ NE
maintenance or improvement?
Waste AnnGcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I@ No
❑ NA El 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window`❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s) � &j"& -OSS #a,,>, Srm, t7+Q)h Msmd
13. Soil type(s) C�Vd56�-M L"
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
q 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
IR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ot No
❑ NA
❑ NE
Comments (refer to question #.}: Explain any YES answers andJnr any recommendations or any other comments.
Ilse drawings of facility to better explain situations. (use additions[ pages as necessary}:
Reviewer/Inspector Name r '?. Phone: 1p��� '3,300
Reviewer/Inspector Signature:Date: $ Zfi
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)$No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes MNo ❑ NA EINE
the appropirate box.
❑ WUP ❑Checklists El Design [I Maps F1 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
bNo
❑ 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
Q 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
2§No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 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
VNo
❑ 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
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 11/28104

Division of Water Quality
Facility Number TO 0 O Division of Soil and Water Conservation
Other Agency
Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
1 11
Date of Visit: �'� Arrival Time: A : t Departure Time. FiFT67Z County:
Farm Name: G�a�a "' „N _ Owner Email:
Owner Name: ��1" C `Qm Phone.-
Mailing
hone:
Mailing Address:
Physical Address:
Facility Contact: -Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: Fr-tS %
Operator Certification Number:
Bach -up Certification Number:
Region: r_?U
Latitude: 0 0 = [=
Longitude: E__1 ° = t 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La cr
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design C1
Cattle Capacity Pop
❑ Dairy Cow
❑ Dairy Calf
❑ Daja Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ELI
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?
r<i
❑ Yes F No ❑ NA ❑ NE
❑ Yes
❑ No
T] NA
❑ NE
❑ Yes
❑ No
T NA
❑ NE
❑ Yes
❑ No
TINA
❑ NE
❑ Yes
[�No
ElNA
[__1NE
ElYes
q No
❑ NA
❑ NE
12/28/04 Continued

' Facility Number: 9—
Date of InspectionO
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 02 NA ❑ NE
Scture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: X1
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.) 10
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes® No El 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 IM 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)
Reviewerllnspector Name ? n Phone:
9. Does any part of the waste management system other than the waste structures require ❑ Yes
"__1 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?
4
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
❑ Outside of Acceptable Crop indow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)r�n
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
No
❑ NA ❑ NE
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
M No
YV
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerllnspector Name ? n Phone:
Reviewer/inspector Signature: Date:
12/28/04 Continued

Yoh
Facility Number: — Date of Inspection fl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes O�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Desigm ❑Maps [:1 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality coneem?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes [bNo ❑ NA ❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
L1 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
12/28/04

Type of Visit 4D Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit:o`�, �DArrival Time: Ll Departure Time: �(] County:
Farm Name: -ra„,, �� &MS Owner Email:
(%�
Owner Name: 1' C5 Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region: 0_
Location of Farm: Latitude: = o =I E__1 ” Longitude: = ° 0 [ = u
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Current
esign Current
❑ NE
Capacity Population Wet Poultry
Capacity Population
CattleWD
apacity Population
❑ Wean to Finish
❑ La er
a. Was the conveyance man-made?
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ NE
❑ Dai Calf
91 Feeder to Finish
❑ No
s ;.;
❑ Dai Heifer
Lj Farrow to WeanF;
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
"a' "'
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
EINE
❑ Beef Feeder
❑ Boars
[:1 Pullets
Elri Turke s
❑ NA
Beef Brood Co
Other
�� ❑ Turkev Points
❑Other
❑Other
12/28/04
Numberof Structures: �
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Mo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[I Yes
El[d No
,�,/
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
BINA
EINE
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
RKA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ON'o
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L�o
❑ NA
EINE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: —5y 1
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [QNo ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 ER 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 �o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Vlo ❑ 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 0Ido ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 054o ❑ 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 i RA
13. Soil type(s) 6_bA.
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
❑ NA
El NE
Reviewer/Inspector Name ��s-}-�� h Phone: 33 00
Reviewer/Inspector Signature: Date:
15. Does the receiving crop and/or land application site need improvement?
El Yes
,�✓RNo
L�' <
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9-3"'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UK
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q1410'
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ��s-}-�� h Phone: 33 00
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

s
Facility Number: — Date of Inspection U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W -UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [j3 No ❑ NA ❑ NE
❑ Yes 13/No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ 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
�%❑
fYJ N
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q'No
[:INA
E]NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
M"N' o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
93'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B/No
❑ NA
❑ NE
Other ]issues
Additional Comments and/or Drawings:'
Page 3 of 3 12/28/04
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/No
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
„��
02
❑ 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
El"No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�(No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:'
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

e
Type of Visit EYCompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:—6�--'�
Arrival Time: �,r� �
Departure Time: � ?i County:
Region:
Farm Name:��..,C3/`GL
rrYL F6CM-If
_. _„. __ Owner Email:
❑ NE
Owner Name: _;7;;� rr%
Gn"�
Phone:
❑ NA
//
i'�fr�wtnf ��G
�4J_Y A/6
KNo
Mailing Address:
_-
S�` uhG^L
❑ NE
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No -
Integrator:, // yy//��r
Operator Certification Number: Z(P&
Back-up Certification Number:
Latitude: ❑ o ❑' ❑ ” Longitude: = n 0 d [� "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
11 ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ 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?
Design :Current:
.Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifei
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes_ notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
KNo
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
5d No
❑ NA
❑ NE
12/28/04 Continued

4
Facility Number: — Date of Inspection rbc
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): v10*7-
❑ Yes 0 No ❑ NA EINE
❑ Yes I No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2QNo ❑ NA EINE
(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 El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 KNo ❑ 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) . � r o.1.:AL #et*, / G. Sau �e h_ first: —
Reviewer/Inspector Name�f ,"" ✓ y': _ Phone: CJIsf/F—
sTr� -- -
Reviewer/Inspector Signature: Date: —
12/28/04 Continued
If , l -
13.
Soil type(s) - az A 0Z 41"
14.
Do the receiving crops diger from those designated in the CAWMP?
❑ Yes
JK No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
XLNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
C�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0,No
❑ NA
❑ NE
Reviewer/Inspector Name�f ,"" ✓ y': _ Phone: CJIsf/F—
sTr� -- -
Reviewer/Inspector Signature: Date: —
12/28/04 Continued

r '►
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps Design g p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J&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 RNo ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;K 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
MNo
❑ 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
10 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;.No
❑ NA
❑ NE
Additional Comments andlor-Drawings:' '
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number J Date of Visit: ��� 7 ` Tame: = G
— 10 Not Operational O Below Threshold
® Permitted [I Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: °� �` �` w. ._ �Z� ,., _�_ _ County: "Oil? .AAl
Owner Name: `; c r r_ .�ie �^ . Phone No:...
NUffing Address: . 3 y S . H C `Y 7 _ 1. a c., n c A/ G 6 s -[ 3 y
Facility Contact: . _ _ _ _. _ _ __ Tile: _ . Phone No:
Onsite Representative: J Y a _Mn--- -- --- ... Inti-ator. ►'
Certified Operator: 3r.. _ .. - w- , _ _ Operator Certification Number: (. cp
Location of Farm:
rM
a] Swine ❑ poultry ❑ Cattle ❑ Horse Latitude Longitude 0 4u
Design Current _ Dessga Cnrtt.
Swine Ca> crtv-Pobnlaiion Poultry .- ' _Caaaciity Poanlatiam: •: Catde ::,
Wean to Feeder
Feeder to Finish .,? p i r
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
"F
Numit'er ali.Logoons
77
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
sign: _ Cnrrmt
cacitt
Poaii
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
M /A
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3 a
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P No
❑ Yes No
Structure 6
12112103 Continued

Facility Number: j — 5 Date of Inspection �';
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [Z No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ yes [P No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ® Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/unprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelrmprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop tYPe,CX �rr re
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAViiW)? ❑ Yes 1% No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is their a lack of adequate waste application equipment? ❑ Yes P No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is their, any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [19 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, oontact a regional ❑ Yes 8 No
Air Quality representative immediately.
if-.11-�`�
3 • 2�-v�� �.
6 . � Mf1 a. 'c`
Y O 12 w'11 h.;,—
r�G"f r,'r��rilrrZ
lt'(%J ck. t..- -}'L,.,*
^ " -4-k.- t
i c r - t c.-�r/ .
Reviewer/iospector Name
Reviewerllnspector Signature:
Feld Copy ❑ Final Notes
`44� �z— c-�4t-2
I( r
1
C
Date: .1 �A! �') 71
12112103 : % Confimud

Facility. umber: — ,� Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling i
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [b No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
U No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Q No
27. Did Reviewerllnspector fail to discuss review/mspection with on-site representative?
❑ Yes
j No
28. Does facility require a follow-up visit by same agency?
❑ Yes
CO No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
P9 Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
)U No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
F No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Q No
r
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted during this visit. You wfil receive no farther correspondence about this visit+
COmm� iian&Uawmgs-F
31 V
12112103