090111_INSPECTIONS_20171231

i
5-'76-- %-3�-�3�
ivisioo of Water Resources
Facility Number x - 0 Division of Soil and Water Conservation
O Other Agency,.
type of Visit: Mompliance 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: ASYT-01 Departure Time: County: , },�J�,�.� Region:
Farm Name: Q ,` "J' y ; J Iln G Owner Email:
Owner Name: r-r__ Phone:
Mailing Address:
Physical Address:
Facility Contact: /%%rQ,,y� Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
f�
Swine
FWean to Finish
Wean to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
Capacity Pop.
Wet Poultry °'
iVIiINF'
Design Current
;:Capacity Pop.
}
sign
Cattle Capacity
Current
Pop.
er
DairyCow
FLa
Non -La er
Dai Calf
iz '`'
- Design
D . P,ouI Ca aci
Current
P.o
DairyHeifer
D Cow
Non-DaiTy
La ers
Beef Stocker
Non -Layers
Beef Feeder
SLIBoars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar2es_and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
f j No
❑ NA
❑ NE
❑ Yes
C2.No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facility Number: - // Date of Inspection:
.I
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 ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ %9-
Observed Freeboard (in): T
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 property addressed and/or managed through a
❑ Yes
E . 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
LR No
❑ NA
❑ NE
,8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
B No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z[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): s' /'W z& ���y�/.S��r f`
13_ Soil Type(s): "71-
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 E3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo ❑ 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 RNo ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 64"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [KNo ❑ 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 [3,,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 C,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 22,No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: Lf - Z& Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fa 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 Q,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:]Yes C&No ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 'Y:�j No ❑ NA ❑ NE
Comrm'ots (referito question #) „Explain auy;YES answers and/or,�any additioi al recommendati6ns or any other coniui6ts.
.. ��^a �; ,
Use drawings of facility, to better explain sitaations'( r ' (tl5e SddIrI011a! p es.as Oemssary
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
T
Date: / Fes: _4 l�
21412015

• _ -.. _ �� tvi"stun of Water Resources-
Faclltty Number` ]� ®I Dtv�is'to''-n�ofrSoil and Water Conservation
v V. OtherWAgency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
��
Reason for Visit: �Komp�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:Departure Time: ,'a� County:
Farm Name: � : ,Jy J FarmI y ✓�7'L %�G Owner Email:
Owner Name: ���,��,r. -, M, 7? �t,cl Gt.r�,-r- Phone:
Mailing Address:
Physical Address:
Facility Contact: A& 7764441 Title: Phone:
Onsite Representative: �s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
�r Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
- =' i
• Desi n C
Design Current - � �H g •urrent
Design Current
S►+•ine Capacity Pop. Wet Poultry Capacity Pop. .CattleM. -
Capacit} Pop-
Wean to Finish Layer Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
, -
n Desi Current
g
Dairy Heifer
Farrow to Wean
U Cow
Non -Dairy
Farrow to Feeder
Dry Poult Ca aci P,o
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
y �
Turkeys
Other
Turkey Poults
Other Qther
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 ofthe 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 KLNo ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑Yes ❑No DNA ONE
❑ Yes ❑ No
[:]Yes ®,No
[:]Yes G�J-No
�] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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): f f /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e... large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®-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
2l No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a 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 [FINo ❑ 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)/hic�Gr_
13. Soil Type(s): �/ o17f
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 ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage R Permit readily available'?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? lfyes, check
[:]Yes
0 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
Eq No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[S No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes JEQ No ❑ NA [] NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
®- No
[] NA
❑ NE
[:]Yes
RNo
❑ NA
❑ NE
[:]Yes
allo
❑ NA
❑ NE
❑ Yes
121-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinEs of facilitv to better explain situations fuse additional gaffes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 122 %2_�2 T—-5-7
Date:
21412015

Fype of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency p Other O Denied Access
Date of Visit: -- A-- rrival Time: Departure Time: �r ..s, i County:
Farm Name: ; ,� �.r. ' 1�Q�'/n �/ G Owner Email:
Owner Name: C�i�,���-s /yJQ ' x�ulr��� Phone:
Mailing Address:
Physical Address:
Region: F;E-V
Facility Contact:Title: ���7 r'f Phone:
Onsite Representative: s' �. —.�� Integrator:
Certified Operator: Certification Number:97�[��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Current Design Current
=` SWine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
L D
Design Current
D . P,oul Ca aci P,o
Layers
Dai Heifer
D Cow
Farrow to Wean
Farrow to Feeder
Non -Da
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Twke Poults
10ther
Beef Brood Cow
....._
Other
Other I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes (. No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

L Facility Number: - Date of inspection: 7r%S
.G
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?:
y
Designed Freeboard (in): 1 /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 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
[allo
❑ 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
[g No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ 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 [B_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. Soil Type(s): IVA+
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 [g 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 ❑ NE
❑ Yes 0 No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ;D-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes CE�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
Z 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes O No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Y
Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
allo
[a NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
[:]Yes 0,No ❑ NA [] NE
❑ Yes fallo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
J.No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Eallo
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[No
❑ NA
❑ NE
Wse :draw
-V r
&z;, d"7-e-r V no
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214112014

Type of Visit: ompfiance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - �j =/ Arrival Time: ' O Departure Time: p County: Region:
Farm Name: X. -,4 pw jE!,w /G Owner Email:
Owner Name: ,� %%%�t�/d Phone:
Mailing Address:
Physical Address:
Facility Contact: �if,�, _- Title: Qe-e d _ — Phone:
Onsite Representative: _ �'cx_�.� _ Integrator: �e¢--
Certified Operator: f Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Design
D , $out Ca aei
Layers
Current
P■o
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
1HPullets
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
[$No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EANo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - J/ Date of Inspection: --/.r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k§-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);�_
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 fallo ❑ 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 )Q No DNA ❑ 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Jallo [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [K No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ..emu/ /O lle04rvl /vi
13. Soil Type(s): j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [53No ❑ 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 h No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z[No
DNA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fZ� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EEq-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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5�.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ®--No
[]NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

IFacili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes U�_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 3 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IM No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Z. No ❑ NA ❑ NE
❑ Yes [2 No
❑ Yes ® No
[:]Yes R!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412014

19
I
Type of Visit: Q'Compli ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' a Departure Time: : a County: Region:
Farm Name: w,p / ;� �r�^t-�. Owner Email:
Owner Name: /�jj� Q/plr rT -� Phone:
Mailing Address:
Physical Address:
Facility Contact: Ad Tr- Title: &9 Wy _ Phone:
Onsite Representative: S'f _ integrator: 3�
Certified Operator: J�a-��� Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Curieat n.,
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
1'op } .
_Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
La er
Non -La er
rn Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Dewy-c-
rentM.
DairyHeifer
D Cow
Farrow to Feeder
D . P,oul
Ca
tNon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
.
Other
Turkey Pouets
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 R1 No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes - allo
[]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: 2t - Date of Inspection: /G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LK 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): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ej� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Cg 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
[2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[2�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cg-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):i�l� `Queonpl_-1'
13. Soil Type(s): /Jo
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 O 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?
Required Records & Documents
❑ Yes allo ❑ NA ❑ NE
[] Yes [E .No ❑ NA ❑ NE
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.
WYes
gklo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard fAWaste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
C,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C.No
❑ NA
❑ NE
Page 2 of 3 - 21412011 Continued

]Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1Q.No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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
No
❑ NA
❑ NE
❑ Yes
ELNo
[DNA
❑ NE
❑ Yes P�g_No ❑ NA ❑ NE
❑ Yes Q�t_No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
[&No
❑ NA
❑ NE
Comments (refer to question# Explain any YES answers and/or any additional recommendations or any other comments_
Use drswings of facility to better *_ 01ain situations (use additional page's as necessary). z<,
a s�� e v'ell/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: c7
Date.
21412011
Page 3 of 3

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: u!, 2 Arrival Time: c3oao r- Departure Time:, c+ oa �-. County: _&AP Region: FRO
Farm Name: F75p MQ:4+ rlfyt-WL,, • 6of.J 1; wner Email:
Owner Name: P 4 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:f Y1 es�
Certified Operator: (k 1 f° S r� I
Sack -up Operator:
Integrator:
Phone:
Certification Number: /�_-_" _r
Certification Number:
Location of Farm: Latitude: Longitude:
# Design Current
Swine Capacity Pop.
Design Current
Wet Poultry , -Capacity Pop.
Design Current
Cattle Capacity Pop.
to Finish
La er
Nan -La er
Dai Cow
to Feeder
Dai Calf
r to Finish
w to Wean
w to Feeder
P
�:.
FDai
Design Current
D . Point Ca aei P,o
Heifer
D Cow
Non -Dairy
w to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
''
Othe
Other
Pullets
Turke s
urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
`P" No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Cg NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
FNA
'�""
❑ 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
o] No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Favili Number: 9- Date of Inspection: 2(a 1 Z
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 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
1!QN
Observed Freeboard (in): �� I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No 0 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 environ ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes �w 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 [)-g 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
f _Crop Window
- j _❑%Evidence of Wind
`�Drift ❑/�Application Outside of Approved Area
12. Crop Type(s): �rri3'�/ f� G 17�r1.ss li C3'mk, V
13. Soil Type(s): AQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
[DNA
❑ 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
[DNA
❑ 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
❑ 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 jy�c No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of inspection: q I2—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 14 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [p] No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ® No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA
❑ NE
Comments (refer to question ft- Explain any YES answers and/or any additional recommendations or any other comments.
rF
Use drawings of facility: to better explain:=situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/
Date:
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint p Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: 0 C' -�--F-i--�� Arrival Time: A9: Departure Time: County: -� J
Region:
Farm Name: P`5-6 , ma4+ 00'' F-"" Owner Email:
Owner Name: %I l r M" e (24c-ln 6o o F-arm Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: It
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: 91--e—SLaL
Certification Number: -! 1 o 5q
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. _
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
affyCow
Wean to Feeder
Feeder to Finish
I INon-Layer I
X"
laOl Design Current.
D . P,oul C a6i Po
Layers IBeef
Dairy Calf
Dairy Heifer
Farrow to Wean i
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Imoacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes IP No ❑ NA ❑ NE
a. Was the conveyance man-made?
[:]Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
® NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facie umber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
q NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: P
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance 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 F No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �j❑�,yEvidence ofWindDrift ❑" Application Outside of Approved Area
12. Crop Type(s): I..OL� la � — .. Ski J i - .0 ,
13. Soil Type(s): / 11 &—f-1-9 I 7V O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
© No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(A 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 50 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 ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FdcitiNumber: - 77771 Date of inspection: f
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 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
R] 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
g] 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
Ig No
DNA
❑ 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
K] No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Vj No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or. any other commenter s �.
Use drawings_ of facility to better:explain situations (use additional pages. as necessary).
F ..
Reea,,JS reJ11,,e q-Iq-11f
f%r Vt �I-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %O—Y33-337crO
Date: l [ 9
21412011

-- 0 ..........Water Quality V
ji=Facifitymber O Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O 0 T j Arrival Time: O.G� if K .Departure Timme: A�,�,, t County: Region:
ROO
Farm Name: PAO, t { Rroi " 061'nboo I ai m Owner Email:
Owner Name: I"o,4 T i- cwdee _. P 5L Phone:
Mailing Address:
Physical Address:
Facility Contact: F'� _ Title:
Onsite Representative: � S L"c 6
Certified Operator: - sq" r
Back-up Operator:
Location of Farm:
Phone No:
Integrator:��s- p
Operator Certification Number: r �0
Back-up Certification Number:
Latitude: =� = f = Longitude: 00 = ' 0 u
Design
Swine Capacity
Current Design
Population Wet Poultry Capacity
C**uri ent
Population
Design Current
Cattle Capacity Population
Wean to Finish
❑ Layer
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 Po ❑NA El NE
❑ Yes
❑ No
� NA
❑ NE
❑Yes
❑ No
qNA
❑ NE
[�)NA
❑ NE
❑ Yes
❑ No
❑ Yes
[fNo
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
Page 1 of 3
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA ElNE
Structug 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
§D No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
qNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop- Window El Evidence of Wind Drift ❑ Application
Outside of Area
f b
Jef 6 6 5i' - o-tt
D
12. Crop type(s) l �1r ,
13. Soil type(s) 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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
Comments (refer to ues"n*' # Ex lam anv YES answers andl ' l y ) P `y * 4, ery R. meats.
{ q organ trecommendatton or an of
Use drawn s of facifi ) p
tv to better explain situations. (use additional pages as necessa
.
�mb ,
Reviewer/Inspector Name l .st 1 w,,„" Phone:
,
Reviewer/Inspector Signature: Date: 3 10
Page 2 of 3 12/2VO4 Continued

r
•
s
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA El NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below, ❑ Yes 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
K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
tB NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphonis loss assessment (PLAT) certification?
❑ Yes
IFI No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q3 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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
fpNo
❑ 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
Ep No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional.COmmepts and/oF DraWings` z Wit, a�
fi. -
r
T
Page 3 of 3 12128104

I
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Wh Departure Time uoq
Farm Name: Falln` n,60 (3
Owner Name:
Mailing Address:
'00 PA I County: M Region: R-0
Email:
Phone:
Physical Address:
Facility Contact: �� Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: SQL. r S n" t'r`' Back-up Certification Number: �st/ t
Location of Farm: Latitude: = o = f 0 u Longitude: = 0 ='
= a
lillLliq�paci�
Design
CurrentrrR)Farrow
n
Wet Poultry Capacity
Population
Cattie
Capacity Population
Finish
❑ La er
❑Dai Cow
Feeder
❑Non -La er
❑Dai Calf
Finish
❑ Dai Heifer
o Wean O
❑ D Cow
o Feeder
❑ Non -Dairy
o Finish
❑ La ers
❑ Beef Stocker
❑ G i Its
❑Non -Layers
eef Feeder
El Beef
❑ Boars
❑
❑ Beef Brood Co
❑ Turkeys
Mel
❑ Other
El ❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
qPNo
❑ 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
1P No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

r
J
s
Facility Number: q—I In
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 No ❑ NA ❑ NE
❑ Yes No WNA ❑ NE
Structure � Structure 6
❑ Yes TINo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑ Yeso El NA ❑ NE
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
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r No
❑ 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 o7'/_ind Drift [:]Application /�Outside of Area
12. Crop type(s) �iiSTGU 17�'�(YY1 �s5 I rf ,'�t �/!1. 6� .
13. Soil type(s) Y Vry'1 ;t o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
❑NA El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 4
Reviewer/Inspector Signature: Date: .z
I&MIU4 Gontrnuea

t
Imo.
Facility Number: — Date of Inspection [Tam
Re wired Records & Documents 1- 1
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box_
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:$No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EPNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
T No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
M No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ip No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments aod/ar 11)rawm
nn
AL
Page 3 of 3 12128104

Type of Visit 4P Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: r27 �Arrival Time: 30 Departure Time:
Farm Name: iA 4 rr ` Hatt TZ� -1-y%— Az�,6) _.Rum
Owner Name:
Mailing Address:
Physical Address:
County: 13LAD Region: PDX
Email:
Phone:
Facility Contact: �+'►a�+l Title: Phone No:
Onsite Representative: ta4 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= e [= ` = Longitude: 0 o = ' = u
P Design Current
Design Current
Design Current
Swine - - Capacity Population
Wet Poultry Capacity Population
Cattle - Capaiy Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ Layers
El Non - Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
El Non -Layers
❑ Beef Feeder
❑ Boars
llets
El Pullets
❑ Beef Brood Co
°-
ElTurkeys
Other -
❑ Other
10 Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
A NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(INA
1[
El 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
PNA
❑ 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
'R No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CnNo
[INA [INE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
PSNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
y rf Y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
gNo
❑ 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
EANo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Wo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > I0% or ] 0 Ibs ❑ 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
IPNo
❑ 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
1P 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_ ^ &5k: Phone:
Fir
Reviewer/Inspector Signature: Date: oZ'7i
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 49 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes P9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F_No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El 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
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
94No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ip No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[PNo
lPNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
[P 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
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'R No
❑ NA
❑ NE
Page 3 of 3 12128104

*JLI
..Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- Q Other Agency
Type of Visit `r"rnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit"VRoutine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /:I Departure Time: County: ' Region:
Farm Name: -6GC Par rY1 2. bvo 1�w M Owner maih
Owner Name: f`t'`Y "_ J;e_t . Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = ` = Longitude: = ° = I = v
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current:
Cattle Capacity Populahofil
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:`
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gjNo ❑ NA ❑ NE
❑ Yes ❑ No F NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No nNA
❑ NE
❑ Yes 0 No ❑ NA
❑ NE
❑ Yes allo ❑ NA
❑ NE
12128104 Continued

•' Facility Number: — ([ Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus hea-vy rainfall) less than adequate?
❑ Yes
P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA ❑ NE
Strue_I Structures 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� 3✓� i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
To
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
ElNA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1�1 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
[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[INA ❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside
of Area
12. Crop type(s) 6-14 � al y 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1P No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
(P No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�LNo
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
JP 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):
a
Reviewer/Inspector NameCHI?4SPAIC &APT00-r Phone:9/0 33 3-
Reviewer/Inspector Signature: Date: D6 W.9 I
12/28/04 Continued

J r
r
Facility Number: — JT Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes} No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other ll
i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ll ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
�Vo
❑ NA
ElNE
ElYes
❑No
'NA
❑ NE
❑ Yes
klio
❑ NA
❑ NE
❑ Yes
—ffNo
❑ NA
❑ NE
❑ Yes
�5 No
❑ NA
❑ NE
❑ Yes
❑ No
�iA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
12129104

Type of Visit 40ko/mpliance Inspection O Operation Review O structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival
Time: l%' r� /Departure Time: �3 County:
Farm Name�At 0 � ro r 171 t � !� �P � ____ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = Longitude: El e = , = u
Design Current
Design
Current
Design Current
Swine Capacity Population
Wet Popltry ,, Capacity
g:J�i�fh"
Population
@stile Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish ❑ La er
❑ Wean to Feeder
❑Non -La er
❑ Feeder to Finish �, ,,
arrow to Wean LIM 1122,
olt - ^
Dry Putry��,�
❑ D Cow
❑ Farrow to Feeder
""`""El
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Beef Feeder
❑ Gilts ❑ Non -Layers
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of structures: a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A 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
�] No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

I
acilittNumber: — 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?
�t.rture 1 Structure 2 Structure 3 Structure 4
Identifier. M 510
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 :30
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 No ❑ NA ❑ NE
❑ Yes No -P NA ❑ NE
Structure 5 Structure 6
❑ Yes TNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PSNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes §5 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) N of fol k V u
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[p No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q9 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
E3 No
❑ NA
ON E
Comments (refer to question #). Explain any YES answers and/or any recommendations.or any other�comrnents.,_
.Use drawings.,of facility'to better explain situations. (use additional pages as necessary)`
Reviewer/Inspector Signature:
�.�11!��►�II'11llliDate:
rage L OJ 3 LZIZAl" L onrtnaea

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rU No ElNA ElNE
the appropriate box. ElWUp ElChecklists ElDesign El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes {A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IM 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
ER 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
® No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: „% dr Arrival Time: f .'1 a Departure Time: County: Jekd4, j ____ Region: FXID
Farm Name: P K, b ba" ra r 1— _ Owner Email:
Owner Name: Pr c.) + C_ c a A Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: a a Integrator: Pr < a+Q.
Certified Operator: a b a r Pro o r Operator Certification Number: 17 7 9,�,'
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ` ❑ " Longitude: ❑ ° = 6 ❑
td
Design Current =, ;Design Curren# Design Current
Swine Capacity Population Wet Poultry "Capaci� ty Paprt'lation Cattle Capacity Population
10: Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wcan to Feeder I a er I Dairy Calf
❑ Feeder to Finish ❑ Dairy Heifer
®Farrow to Wean -7S l� DryPou�tr} 1? . ❑ Dry Cow
i s ❑ Farrow to Feeder ❑ Non-DaiEy
-` ❑ Farrow to Finish ❑ La ers
}.; El Beef Stocker
❑ Gilts ❑Non -La ers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Co
9 r7 ❑ Turlce s , . -
a
Other t�`F ❑ Turke Pointst
❑ Other
❑ Other
Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ 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?
12128104
Continued

I
Facility Number: — 1 / I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [)-a 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): �31 r [-
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
91 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[jj No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffets, setbacks, or compliance alternatives that need
❑ Yes
rV1 No
YU
❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s) /V,
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
[11 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
5 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
Ae/?70vc i�9J5 �—.s _5e5azu 0 j pbSS t o 1C
Reviewer/InspectorName`p /� /" �=°` Fes_ Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 9 — �J/ Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
/. 5
❑ 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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes(]
No
❑ NA
❑ NE
❑ Yes
44-1 No
ElNA
❑ NE
❑ Yes
6a No
❑ NA
❑ NE
El Yes
RNo
El NA
El NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑Yes ®No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
F0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
Addih'o"iaaltComments?and/or Drawings
12128104
12128104

I
0f
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine Q Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number Date of visit: :? 1 d Tune: I t o
Not Operational O Below Threshold
Elfermitted VCertifiedM Co R sGnally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: �.f~. J,Q PP .. &, &-el l y,,,6r Fa, .+, County: 1 11 n
Owner Name: , a _ (Lt?l�.�y Phone No: 1710 -G LIL-
Mailing Address: �3DY___ - h&IL,uaa _&t'✓e jFr za e� & C 2 b 3 3�f
l G � �rtrCd .... Title: ci 0` 5'512 - P721
Facility Contact: __......... _- __-.. .Phone .- ,,,[.-.-
Onsite Representative - Integrator: �r
Certified Operator:. Gad------- - NeAl Operator Certification Number -
Location of Farm:
9'<wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude •
esIM
.Carrez
swine F rrPnnnll b
t` tv ePOniilatien' 'Cattle C�emcdvr_Pdaiilatir�n:
wean to Feeder
=t
Layer
Feeder to Finish
y
Non -Layer
arrow to Wean
n
Farrow to Feeder`
Farrow to Finish
`� " Tat Desy
Gilts"
Boars
r�
7 ._
Dischames & Stream Ian acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade?
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes Ewo
❑ Yes [Ko
❑ Yes [-Io
❑ Yes EK
❑ Yes [210
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E; 4o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ea<0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ---- _ ..._.- . _
Freeboard (inches): 3
12112103 Corfinued

Fac7ity Number: — J j Date of Inspection 12' -o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
B<O
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[]'<o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
2<o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
2Vo
elevation markings?
Waste Anm:cation
10. Are there any buffers that need maintenance!maprovement?
❑ Yes
10
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12- Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�, �
L._f<o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
0'N- o
16. Is there a lack of adequate waste application equipment?
❑ Yes
LSO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes • [ No
19. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt, ❑ Yes [no
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 2do
Air Quality representative immediately.
tiu bc:te�-fit 1 9}' field copy p Final Notes
All
%� ,/
► l e c 6 -1iJ 4 e- ", (e w Gd J 1- 34?D- o ff
r
s^^.—•emu.., . n,.irn
E
werAUwpmtor Name M //� 'rr'�K a �wer/Inspector Signature: Date: Z9 3 a
12112103 Congaed

Facility Number: — j Date of Inspection _ a
Required Records & Document;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/iaspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Epq'o
❑ Yes [}4qO'-'
❑ Yes EINC
❑ Yes cgv&
❑ Yes U-NU
❑ Yes ❑3+ior
❑ Yes [INV
❑ Yes ado
❑ Yes EY90
PhYes ❑ No
❑ Yes allo
❑ Yes 0-M
❑ Yes O-NO
❑ Yes E3N&--
0 Yes 04le-
12112103

14
Site Requires Immediate Attention: 1V0
Facility No. 0 17-dW i ! /
DIVISION OF ENVIRONMENTAL MANAGFME TT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 - 1 q , I995
Time: 13 ; SS
Farm Name/Owner: M a 44- 14a v J e_e. # 3 5 (o / n1 a P-de e_
.Mailing Address: PO 0 /57 E ,• C Z 8 3 3 7
County: Ala e.✓
Integrator: res t t_ Phone:
On Site Representative: 106l f af. _, Phone: (9 -) &1(5- l�753Co
Physical Address/Location: S /o0 3 fL. f'Y�Y.,._ S 7-
a 4?r� X. 3j,1 r4 /�
Type of Operation: Swine 4% Poultry Cattle
Design Capacity: Number of Animals on Site: & z 4
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: w
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6e r No Actual Freeboard: 2- Ft. Inches
Was any seepage observed from the la n(s)? Yes or�Was any erosion observed? Yes
Is adequate land available for spray? la
llo Is the cover crop adequate? Yes or No
Crop(s) being utilized: Leas- /
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? or No
100 Feet from Wells? aWor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orW
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 049
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oz(&) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? <jjs,:4r No
Additional Comments:
It ct r) e S A l V e r e. -z
:Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: AO
Facility No.
a'?— // /
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: S
Farm Name/Owner:
Mailing Address:_ PO l3a7t_ /5'7 (o _ �j, Z a toe d-k"r,✓. NC _z 2337
County:_ f3la de ,✓-
integrator:_ _ Pres fvgc F, ms - _ AI _ Phone:
On Site Representative:_ Adk ,Al-6-a/« Phone: (9io�--
Physical Address/Location:_
Type of Operation: Swine Poultry Cattle
Design Capacity: 2-0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (YiDor No Actual Freeboard: Z Ft. Inches
Was any seepage observed from the lagoon(s)? Yes orejo Was any erosion observed? Yes orQ
Is adequate land available for spray? or No Is the cover crop adequate? Sbor No
Crop(s) being utilized:_ r- --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? eT`e`§ or No
100 Feet from Wells? or
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes orM
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(s
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 63�or No
Additional Comments:
JUL `
ENV
-�---
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTE ChROLIM DIKPARTXMQT OF , HRALTB' b NATURAL RESOURCES
Fayetteville Regional office
Animal Operation Compliance Inspection Form
r�=:FgRK;FARHi.=I+iL
:.4x
l of 4 Hardee/
♦ate M�fi '. -.. ...n._Y-n•.... x`„vY.....fiA�Y!.+•tiV jj �^•.-fin.. �
� Y.y y� �� �{��,� y,�y����p.y S<l+•. Y"r..gqti b:f
L,'",'„tYfJ.lwj.ifl7
�+!%w" ��iY.. �:.�i�., :'^:.ji. nr' �^! irz.N. .+wa. .�J�.
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w�ill.iJJlil.'.i �
, n2{Ll�i{A.iVi ��•� F�•"�`°T
.ar9Vi'1�?,•%
LLrii II►li\t. ..37iit1a�
157(o IiMbe r[oxsn,N
"33`7 QIU -~ 5-6796
All questions answered negatively Will be discussed in sufficient detail in
the -Comments section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION r
Animal Operation Type: rC(,rro v6 f-1,9 (6224)
Horses, cattle, j!!wine poultry, or sheep
uff© • .a
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),..and
poultry (30,000 birds with liquid Waste
system)) -
2. Does this facility meet criteria for
Animal Operation REGI5TRAT30�+.
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4 _ Does this facility have a CERTIFIED Al�I3�lAL
iiASTE 1+ MAGME TP PkW.
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?

EIMON III
rAeld Site mans ammt
I. Is animal waste stockpiled or lagoon
construction within 100 It. of a USGS
Map Niue Line stream?
2. Is animal waste land applied or spray
irrigated within 25.ft. of a QSGS Map
Blue Ia ae Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover clop in accordance' with the
MT_1PICATIOTt PLAY?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CA' ON?
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _)
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SLC' ON IV
Comments
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