090077_INSPECTIONS_20171231

z
i ype or visit: k:;vt.ompnance inspection v vperanon Keview v structure r valuation V i ecnmcai Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: ' pfl Departure Time:County: --� Region:
Farm Name: /)uOwner Email:
Owner Name:1.?j�'3[�� s�`.-y�j ' �-�— Phone:
Mailing Address:
Physical Address:
Facility Contact: tir Ai Title: Phone: /%
Onsite Representative: f�,�c� Integrator: r/d'
Certified Operator: ys-rd�S �;,.� _ _ Certification Number: %fa 7,-z4
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design Current
Design Cnrren#
Swine :. Capacity Pop. _
Weta'oultry
Capacity Pop.
Cattle x Capacity Pop:
Wean to Finish
Ej�_No
La er
❑ NE
Dai Cow
Wean to Feeder
LaLer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design' 'Current
D Cow
Farrow to Feeder
D • Poult .
Ca ac' , , P■o
Non -Dairy
Farrow to Finish
l aye
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other, :;. I . ;,;
Turkey Poults.
Other
Other
�Ill�i-�_vudvlilli� �i.:,iiLaS€�•e.in..:--:.. ...:`.�:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Ej�_No
❑ NA
❑ NE
Page 1 of 2/4/2015 Continued

ti
Facili Number: 7- Date of inspection:
Waste Collection & Treatment ,�,,,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rlo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2]'1q0
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[2 wu
[] NA
❑ NE
waste management or closure plan?
If any of questions 46 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
[�io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�Jo
❑ 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
D-1ro
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
ff o
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 050 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): eVryk
13. Soil Type(s): 4: '0'tf Z 1,lJY f [; .4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3<o ❑ 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 E fro ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [3-lq-o ❑ NA ❑ NE
❑ Yes E3 -N -o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3'1Cio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q'11To ❑ 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 [T -RI
F] Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
FI Rainfall F] Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Q Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 1:1 Yes �o`
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Conlinued

[Facility Number: jDate of los ecHon: !
w
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2LNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�jNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA F] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 Yes �No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [� oo ❑ NA ❑ NE
❑Yes
�o
❑NA
❑NE
❑ Yes
E] -5o
❑ NA
❑ NE
[] Yes
Cj`No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/ Inspector Signatui
Page 3 of 3
Phone: `lrl0 30�'�O(5 i
Date:
21412015

i
,
—
Factl� Number �, Division of soil and WaterCoAservation
., ®:Other Agency
Type of Visit: om liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q ' p Departure Time: n County: Region: L�
Farm Name: ees Alalfr!I Owner Email:
Owner Name: _ may-'t<rs ' Iy IJ AL.1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: r� Phone:
100,
Onsite Representative:Integrator:
Certified Operator: rs /z, Certification Number: / L 7pzfd
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'jEq_t�D ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Dest n Current
'g Design Current..,:.
:...5 � Design Current
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
acity Popa, Wet Poultry Capaci
Lf
❑ Yes
F�)C
Finish`
Laye
Dai Cow
❑ Yes
Feeder
Non -La er I
Dairy Calf
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Feeder to Finish'"-
;=
Dai Heifer
❑ NE
Farrow to Wean
Design Cut• =y'.
rren
Dry Cow
Farrow to Feeder
::_ D , P,oultr. Ca acity P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
�
E Turke Poults
2 i
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'jEq_t�D ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412015 Continued

Facili Number: - Date of Ins ection: ?i 7
Waste Collection & Treatment
• 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fa 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
SKNo
❑ 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
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes UZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
7
12. Crop Type(s):
13. Soil ZZ/147
l,�/C ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�"o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes If No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes FeNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes §� No ❑ NA ❑ NE
❑ Yes 15� No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 54 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 21-Y es o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard '[2�Waste Analysis ❑ Soii Analysis p Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" RainfalWs
ctions ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ;8 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 21412015 Continued

Facility Number: - 7 Date of[ns ection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes oleo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes SNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
qNo
❑ 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
W 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
5No
0 NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: __V {SK
Date:
2/4/2015

Date of Visit: -- / Arrival Time: (?J Departure Time: County: .o•� Region:
Farm Name: Owner Email:
Owner Name: -, .�� s �' %z, _ Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: /���,str✓
Integrator:%/ ��
Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: �Ji A
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I IMon-Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
i i r_-rr e.
Dry Cow
Farrow to Feeder
D . P,oultry
Ca aci
P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes [Z No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes PTo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Wo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

F
Facility Number: 17 - 71 Date of Inspection: rT 7-1Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [K No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑NA E] NE
Structure 1 Structure 2 Structure 3 Structure 4 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
(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 [a No ❑ NA C] 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 allo [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes RNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 4
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Sail Type(s): (/ d W , /Cr1 -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [INo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[]Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[n No
❑ NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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 [X No
[] NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a 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 }allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes CE 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
[3 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
[Q 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
O No
0 NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 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
[allo
❑ NA
❑ NE
Comments (refer to question#)Exptafi a6y._,X S�answersFandlor any'additlpnal'reCOmmeAdaliOns or any other comments"
Use drawings of fa st�ations�(use addit,onal:pagesfas,_necessary):'s4 -_: ` ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

type or visit: *-7iinspection v uperation Keview V arrucrure e,vaivation V iecnmcni,Lssisrance
Reason for Visit:outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: © Arrival Time: Departure Time: !1-( County:'&'z.--� Region:
Farm Name: tf-'v Owner Email:
Owner Name: gyy�� i�'� Phone:
Mailing Address:
Physical Address:
Facility Contact: �� f, ,� l toyr-- Title: Phone:
Onsite Representative: Integrator: 'Oy'f"OF4, X�CA)A- -
Certified Operator: Certification Number:4—
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet Pointry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Weto Feeder pD
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
s,
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Paul
@a a_ '
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turke s
Other
Turkey Poults
Other
1 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ Yes
V -No
❑ Yes
04No
❑ NA ❑ NE
C3 NA F] NE
❑ NA ❑ NE
Page 1 of 3 2/4/2014 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [Z No
[DNA
❑ 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Z No
❑ NA
0 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 ZI No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload D 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
1
12. Crop Type(s):--
13. Soil Type(s): J &( r 1 �1
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes ®No ❑NA ONE
❑ Yes (3 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z[No [] NA [] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E,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? 0 Yes No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: jDate of Inspection:
3`41-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Dq No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains -exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ®.No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes O_No ❑ NA ❑ NE
❑ Yes Z[No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes S -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question,#): Explain any YES;answers andLor:any additional recommendations or any o"cher 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`30b
Date: �La
2/4/2011

I
ivision of Water Quality( — 1
Facility Number E 0 Division of Soil and Water Conservation
® Other Agency
Type of Visit: C.E�i�liaa ce Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:Departure Time: County: Region: otfZ5 p
Farm Name: /��� Owner Email:
Owner Name: / j.1{� i%7—� :.-L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: /%sem✓ �/-'L�
Certified Operator:
Back-up Operator:
Certification Number: %&7,-z,6
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NNo [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
Design Current �;�F
Design
Current
'' Design Current
Swine
Capacity Pop.Wet Poultry
Capacity
Pap.
Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
[Layer
Nm -Layer
Dai Cow
Dai Calf
Feeder to Finish
Farrow to Wean
#"f `°
,y.
Design
Current
Dairy Heifer
Cow
Farrow to FeederD
�P,oul# 4.
C►a aei
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 NNo [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
JNo
[DNA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: -77 Date of Inspection: �
❑ Yes
E� No
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(3 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
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in): 19
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
® No
❑ NA
Observed Freeboard (in): !`1`
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield [] 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
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.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�j No
❑ NA
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
r No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R� 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
2q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
�is
12. Crop Type(s): -1 X lf'4„ :��/ 7! �-. s __
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ 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
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�j No
❑ NA
❑ NE
Page 2 of 3
f
2/4/2011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FL No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:)Yes fo 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 ffj No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No [DNA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes
,j No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
2!�No
❑ NA
❑ NE
Comments (refer to: question #): Explain any YES answers and/or any additional recommendations or any other comnaeats ;°
Use dra"wines ot-facility to better explain situations (use additional pap -es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:d�-�
Date:
21412011

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:/0,'=,0Departure Time: County: Region:
Farm Name: ` Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: /
Facility Contact:/isls� /X���j Title:Phone:
Onsite Representative: ��,�n�y.� a,.r.a,r� Integrator:
Certified Operator: Certification Number: %-(o
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
-�.?
Design
Current
Design Current
Swine Capacity Pop.
Wet Pond'
Capacity
Pop.
Cattle C*apacity Pop.
w
Wean to Finish
La er
Dairy Cow
Wean to Feeder p D O
Non-LLer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D`�Poult -'`
C+a aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes C.No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes D No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Cg No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

[Facility Number: - 7 7 jDate of Inspection:
a
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EgNo
❑ 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
[q 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
E2J No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R 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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
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 SNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):--
13_ Soil Type(s): l�D We Z!�: b -- -
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 EgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes El No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes S No ❑ NA D 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 necd improvement? If yes, check the appropriate box below. 0 Yes [a 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 [6 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - % 7 Date of Inspection: — -5-13
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 E No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
and report mortality rates that were higher than normal?
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
If yes, contact a regional Air Quality representative immediately.
❑NA
❑NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E -No
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA
❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ No
34. Does the facility require a follow-up visit by the same agency'
❑ Yes
No
refer h)o question.#): Explain any YES answers: and/or any additional
;s of facility.to better: explain situations {use additional pages as neces
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
or any other
❑NA E] NE
❑NA F] NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
�mntents*
Phone: %/O Gi _3_%X330C'
Date: S —1 3
2/412011

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: autine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: 0, Departure Time: ,' County: f— Region:
Farm Name:_ 'gaw � Owner Email:
Owner Name: 3Yn�C S%�,��?4 y�y,` Phone:
Mailing Address:
Physical Address:
Facility Contact: �,� Zr/' 446111 Title: No -in e e---- Phone:
Onsite Representative: Integrator: IX .
Certified Operator: Certification Number: / k2Zfd
n
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Design rtCtirrent
KNo
Design
Current
Design Current
e'
Capac ty� Pop.
Wet Pauliry
Capacity
Pop
Cattle Capacity P.
❑ No
#:
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
to Finish
❑ NE
La er
Dai Cow
to Feeder
Q� —=�
Non -La er
[:]No
❑ NA
Dai Calf
r to Finish
[:]Yes
®.No
❑ NA
❑ NE
Dai Heifer
w to Wean
r7Farrow
Callo
❑ NA
Design
Current
D Cow
w to Feeder
D . Poul
Ca aei
P■o
Non -Dairy
to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.::..:1.... _
Turke s
Wither
Turkey Po Its
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
®.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Callo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

FaciliNumber: Date of Inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ .NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Z No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
C. No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[SNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): 1- Gvf1 r Y
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tom? No
DNA
❑ 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
JR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
[-]NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
{ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Callo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o ❑ NA ❑ NE
Jai Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes E] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes S No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
❑ Yes C. No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes S[No
[—]Yes fZ�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawings of facility to better explain situations (use additiotial a�esras necessary)' '- '; Y
Comments (refer. to question #f): Explain any YES answers and/or any additional recommendations or an outer comments:
use 301b3 &� W�ej`� '1� 7 com a �`-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '/
Date:
2/412011

0
Type of Visit tMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 1 %0, uD Departure Time: County: -Z74Region:
Farm Name: 004e 1` Owner Email:
Owner Name: zr>� w Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: T— Phone No:
Onsite Representative: 3,_A, _ Integrator: ✓
Certified Operator: 1.4'� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e =I=" Longitude: = ° "
Design Current
Capacity Population
*:_ Design Current
Wet PoultryCapcity population
Design Current
@attle Capacity Papulation
Fe-
ean to Finish
❑ La er
❑ Dai Cowean
to Feeder
❑Non -La er
❑ Dai Calf
eder to Finish
❑ Yes
Dairy Heifer
W
❑ Farrow to Wean
Dry Poultry. +__ '
❑ Dry Cow
❑ Farrow to Feeder
❑ No
❑ Non -Dairy
Farrow to Finish
❑ Layers
Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
F] Beef Brood Co
❑ NA
E:1 Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
D9 -No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
SNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

12. Crop type(s)
13. Soil type(s) 6�&el lL(% / 1.9"
Facility Number: —
Date of Inspection /� !
14. Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & Treatment
❑ No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes � No
El NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes
❑ No
Observed Freeboard (in): �¢
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JZ 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 JZ No
[:INA ❑NE
through a waste management or closure pian?
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 A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [SNo
❑ 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 R No
[]NA ❑NE
maintenance or improvement?
Waste A plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )Q No
❑ NA ❑ NE
maintenance/improvement?
It. 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) 6�&el lL(% / 1.9"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name f Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 72/28/04 Condnued

Facility Number: — Date of Inspection U 72-1
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CgNo [:INA ❑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
S 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
f0 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
[Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5No
❑ NA
❑ NE
AddifionalsComments,andlor
Drawings .--
_�To
77te
Page 3 of 3 12/28/04

---vision of Water Quality
Facility Number Division of Sohl and Water Conservation
Outer Agency
Type of Visit (<o—m— pliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: j0 Arrival Time: ` ••D D Departure Time: County: &-, Region:-�
Farm Name: l:Of- y ur-S�r�y Owner Email:
Owner Name: nri, /n�Lvi — Phone:
Mailing Address:
Physical Address:
Facility Contact:yrnr+ti/ //6�1Yr``�-- Title: 0hY _ Phone No:
Onsite Representative: „ dam- `flc� rt n r__r Integrator• ,"j k&;41
Certified Operator: � � Operator Certification Number: 2
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =I = " Longitude: =0=.
°=. = 1{
Design Current.
Design Current
Design Current
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Ir!Wean
❑ Layer
❑ Dai Cow
=Feeder 'f�
❑ Non -La er
❑ NA
❑ Dai Calf
❑ Yes
❑ No
❑ Dai Heifer
w to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
;r.VilNo
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
El Beef Feeder
PCBoars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ 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 5U.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Eg�No
❑ NA
❑ NE
El Yes
;r.VilNo
❑NA
EINE
Page I of 3 12/28/04 Continued

Facility Number: — 77 Date of Inspection F-7-1dH,0
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes �No El NA F-1 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El 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 Ed 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C& No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L9 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) �2fIAZr, (�' i
14_
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ft-wo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ovo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
14 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�a No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P..No
❑ NA
❑ NE
Comments (efer to question #fj Egpiain any YES -answers and/or anyecomniendahonso�rrany other comments
Use draH�ngs of facility to better explainsituations. (use additional pages as necessm,.y
�t :r.. _
Reviewer/Inspector Name � "> �� ��� �� ;:. Phone:
Reviewer/Inspector Signature: Date: % !moi p,�171
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ALNo [INA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design F-1 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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
J. No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g] No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
j4No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
29 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,KNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
jffNo
❑ 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
JRkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RZNo
❑ NA
❑ NE
Additional Comments and7ifr Drawings
H
Page 3 of 3 12/28/04

y
Type of Visit ( ompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (A<outine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: E_� Arrival Time: L7 : Departure Time: �D County: yw Region:
Farm Name: ✓ B Owner Email:
Owner Name: r11 y1 Phone:
Mailing Address:
Physical Address:
Facility Contact: /,(j0M!U f.�/Y,J u, &I- Title: I Phone No:
Onsite Representative: � �.�_�rrn_ 7- 2&& Integrator: Myrellog
Certified Operator: D,11a 6 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [:] o [--] ' F__j W Longitude: [= o = t =is
0414_1
❑ Yes
urrenine
city Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
[j Dairy Cow
Wean to Feeder D0 —0—
❑ Non -Layer
E] Dairy Calf
E] Feeder to Finish
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
El Farrow to Finish
❑Non -La Non -Layers
❑ Beef Stocker
❑ Gilts
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Beef Feeder
Boars
❑ Pullets❑
❑ Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
El Turke s
BNo
Qther
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures
❑ Yes
IRNo
❑ NA
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Klo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
BNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IRNo
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

0
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Stnieture l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard Or*
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 6
❑ Yes IR No ❑ NA ❑ NE
❑ Yes CgNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D�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
KNo
❑ NA ❑ NE
maintenance or improvement?
Wnste application
10. Are there any required buffers, setbacks, or compliance ahernatives that need ❑ Yes
(&No
❑ NA ❑ NE
maintenanceru nptuvement?
11. U there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
D�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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 "e(s)I A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
5tNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Wo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[-] Yes
Q� No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
2�No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 -No
❑ NA ❑ NE
-6mmetits (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 e ( Phone:
Reviewer/lnspector Signature: Date: _eLff-
01
fl a�
12128/04 Continued

Facility Number: — Date of Inspection L�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A 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 ❑ Desi Maps Design ❑ ap ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 KNo ❑ 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
[XNo
❑ 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
D9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[5LNo
❑ NA
❑ NE
General Permit? (id discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
tjNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit Q<ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e-RQUtine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I ('` Arrirva/i Time: ��f� Departure Time: i` County:. •^— Region:
Farm Name: Owner Email:
Owner Name: f Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:Gs Integrator: `l.�
Certified Operator: d5 /�'<� '�— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
= Longitude: =0=6
°=6
I' Design MCurrent Design Cne Capacity Populattori :'Vet Poulopulahon�-,�CattEe Capacity Population
❑ Wean to Finish ❑ La er
Dairy Cow
awean to Feeder ❑ Non -Layer I ❑ Dairy Calf
❑ Feeder to Finish �''"
❑ Dairy Heifer MD nPoultr.3ElFarrow to Wean [] D Cow
Dry
❑ Farrow to Feeder "`.r ❑ Non -Dairy
❑ Farrow to Finish El Layers
El Beef Stocker
❑ Gilts
Non -Layers ❑ Beef Feeder
❑Boars v El s.
❑ Beef Brood Co
k : ❑ Turkeys � �; .
Otherk El Poults k`
❑ Other ❑Other Number of Structures:
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes [0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O No
❑ NA
❑ NE
other than from a discharge?
12/28/44 Continued

Facility Number: CV — Date of Inspection
+` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9No []NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in): lf�_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JRJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Rj No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19 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 Z.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JZ.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
J9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RjNo
❑ NA
❑ NE
Reviewer/Inspector Name: '`,F"� Phone: 12f-Gj'��
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128/04 Continued

Facility Number: —%% Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes `® No ❑ NA ❑ NE
the appropiate box. ❑ WDP ❑ Checklists ❑ Design g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes f allo ❑ 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 M No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes P No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes V1 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 9No ❑ NA ❑ NE
Other Issues
28. Werc-any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,No
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
[ANo
❑ 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
44No
❑ 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
Ej3_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
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
j9 -No
❑ NA
❑ NE
Page 3 of 3 1212$/04

ivision of Water Quality
Facility Number ' 7 O Division of Soil and Water Conservation G�
O Other Agency
Type of Visitommppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Arrival Time:
Q .3 � Departure Time: 0 " j70__1 County:
Farm Name: j Owner Email:
II
Owner Name: �G `+ di ''t Phone:
Mailing Address:
Physical Address: ,y�
Facility Contact: / /t b�M4s Mi—VI V, I^ Title: Phone No:
Onsite Representative: :5r i � Integrator:
Certified Operator: `3Ar*-�--2� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: EA o =' = Longitude: = ° = I = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I F 1101 La er
Wean to Feeder 0 1 ILI Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .
❑ Other
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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
❑ Dairy Heifej
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
,�. _I•i
Number of Structures:
s�
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 29 No ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
PjLNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 1-271 Date of Inspection O a
Soil type(s) �' 6OA- /IXJC /tZ
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes JSNo
❑ 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:
MNo
❑ NA
❑ NE
Spillway?:
Does the facility lack adequate acreage for land application?
❑ Yes
M No
Designed Freeboard (in):
❑ NE
18.
Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):
Z[No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes KNo
❑ 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 §9 No ❑ NA ❑ NE
S. 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 IR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Jallo ❑ 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) �' 6OA- /IXJC /tZ
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
MNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Z[No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
aA
Reviewer/inspector Name Phone: }'/ D —y� 3[70
Reviewer/Inspector Signature: Date: O

Facility Number: — Date of InspectionT
J
' 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 VSNo [JNA ❑ NE
the appropiate box. ❑ WUP ❑ Checklistsgn
❑Desi ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ryes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes BNo ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C3,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ 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
(RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14 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
KNo
❑ 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
VS.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
JZ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PtNo
❑ NA
❑ NE
Comments and/or Drawings:
12128/04

Type of Visit OwC—ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Arrival Time: ; 3
Departure Time: l ,� 17 1 County:
—^- Region: C7
Farm Name:
0'
Owner Email:
❑ NE
Owner Name: Ljr i—>� Phone:
Mailing Address:
Physical Address:
Facility Contact: gj� 1/ l' v'L Title:
Onsite Representative: SA'*' r
Certified Operator: s�—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=4
Longitude: = ° = i = u
Design C►urre>at
Design Current
Design Current
EINE
Swine C*apacity Population
Wet Poultry Capacity Population
Cattle Capacity Papulation
❑ NE
❑ Yes
❑ Wean to Finish
❑ Layer
❑ NE
❑ Dairy Cow
J9 No
❑ NA
Wean to Feeder G
❑ Non -Layer I
10 No
❑ Dairy Calf
❑ NE
FroFeeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars I I
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
IIIE] Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
[I Yes
5 N
El NA
EINE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
fN No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
Page l of 3 12/28/04 Continued

Facility Number: — ? Date of Inspection F
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 RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 54No ❑ 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 JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ 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) e !¢,qr m 1St' +hY S llejh-✓
13. Soil type(s) �'?� f} /&I , � a, /, / �f ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t�RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EK No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Comments�,(refer to question #) . Explam any YES answers and/or any recommenkdat�ons or ally other commentsh .:
I3se drawings 6f facility to better explain situations: {use additional pages as necessary) �t
r
Reviewer/inspector Name �rV _ � �� re ,,;; � Phone:
Reviewer/inspector Signature: Date: 9 — ,-ZO rD b
Page 2 of 3 12128/04 Continued

Facility Number: — % Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 53 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tZNo ❑ 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
P9 No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
UjNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J.No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U3 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E,No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
29 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
A No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1z
Page 3 of 3 12/28/04

f
Type of Visit ® Compliance Inspection O Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: //'dz'OS Arrival Time: jZ:/S� m Departure Time: County: rtela-A-A.
Farm Name: �._ Ntltrsel -ed Owner Email:
Owner Name: 7�— IffeZ mit/ Phone: 10 5-2 9– /z72
Region:
Mailing Address:
Physical Address:
Facility Contact: M!, MCA vi Title: Phone No:
Onsite Representative: &vitj R (oPj:5o Integrator: Alloy4Ai – S" LIJA/
Certified Operator: Ne VII Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' [—] ' =" Longitude: = o =' = "
=l Design C*urrent
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
WDes>gn
Current
Design CurrentSwineoulationpacity
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
*Poaulation
Cattle Capacity Population
❑ Wean to Finish
❑ Yes
❑ La er
❑ NA
❑ Dai Cow
Wean to Feeder
2 O
❑Non -La er
❑ NA
❑ Dai Calf
Feeder to Finish:
..'"
❑ Dai Heifei
❑ Farrow to Wean
❑ Yes
® No
.yam .,
�.
. k r ��
"�""
❑ D Cow
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
Dry Poultry
& y
❑ NE
❑ Farrow to Feeder`""
❑ Yes
® No
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
❑
❑ Beef Stocker
❑ Gilts
12/28/04
❑Non -La ers
Non-ersLayers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Turkeys
Other
��
❑ Turkey Poults
❑ Other❑
Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
19 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
W No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[9 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
® No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge'?
12/28/04
Continued

Facility Number: Q I — 77 Date of Inspection — Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).-
in):Observed
ObservedFreeboard (in): g�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U) 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
A No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® 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
al No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Go rN , SO •, b e RNs e-4+
13. Soil type(s) Go A i,.J e- - G 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes
W No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[M No
❑ NA ❑ NE
Reviewer/Inspector Name 11°� eVe �s' }",} r , Phone:
Reviewer/Inspector Signature: Date: /— DZ — d
12/28/04 Continued

Facility Number: 49 - 77 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K] No ❑ NA EINE
❑ 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
X NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
P] 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
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CO 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
23 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X1 No
❑ NA
❑ NE
Add�honal Comments ani or.: rawings
12/28/04

Facility Number 4%' 7
Date //' z - 15'1'
Name .^Ao,,g -s (/TSA!y ltle lug ^l
Farm Name /lbw 1.s� �7
C.O.C. permitted on hand
Waste plan Soil Test J PLAT Deep Soil test
Soil type
Crop types
Af
Designed Freeboard
Rain gauge Rain breakers
Observed Freeboard $
/J% Daily Rainfall
Calibration of spray equipment A10- G.P.M.
Sludge Survey /V/,f- Crop Yield 120 minute inspections
1 in. rain inspections f Weather- code Weekly Freeboard
Waste Transfers nJl,4- Waste Analysis
Pumping time
Waste Analysis % & Month
Comments: