090135_INSPECTIONS_20171231

Type of Visit: EKompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: routine 0 Complaint Q Fallow -up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: r t} Arrival Time: ; pD Departure Time: ! t]! County:
Farm Name: V dYvL_ = Owner Email:
Owner Name: t �' S �,r- _ Phone:
Mailing Address:
Physical Address:
Region: U!b
Facility Contact: C Title: z?,y,01 ,-v- Phone:
Onsite Representative: Integrator: fry, & t/4
Certified Operator: Sir�•� Certification Number:�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
-
Design
Current
Design
Current x Design Current
Swine
Capacity
Pop. Wt Poultry-
Capacity
Pop C le Capacity Pop.
y
Wean to Finish.
Layer
Da Cow
Wean to Feeder
Dp
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current Dry Cow
Farrow to Feeder
a
Caci
-`
P,o � -, Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
NOD -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeysg�_
Qther
Turkey Poults
Other
Otherk
Discharges and Stream Im-pacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Eg-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 4�g_No
❑ Yes Z .No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: - IDate of Inspection:
D�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in): ---
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
0 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
JR 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 Auptiication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P§-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ [] Yes ff�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):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jallo D NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes MNo ❑ 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
ZLNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V�J'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
D� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
[R No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
1No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: -77 f jDate of Inspection: V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes DI -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 gLNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 t. 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
0 Yes [EgNo ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes [, No
❑ Yes ONo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #.) Ezplarn,any_YES answers and/or any additional_ recommendations or any other comm" 6.n s ,
Use drawings. of facility to�be#ter ei Aii ii situations (use additionai. pages. as necessary x +;
Reviewer/Inspector Name:
Phone: �Q'3e,�'19
Reviewer/Inspector Signature: _ �Date:
Page 3 of 3 21412015

5fi6­ q /7- /4_'e'�
Type of Visit: (D-�mptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0-1t6uttne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: a
Departure Time: '.
County: X�ll
Farm Name:
9—c- 1-2-
Owner Email:
Owner Name:
7c-
Phone:
Mailing Address:
Physical Address:
Facility Contact: 0-01 el -�Z,9_ T -er- Title: ,yz//7 r- J Phone:
Onsite Representative: S�
Certified Operator:
Region: IF-_7ZO
Integrator: M ►'� ""
OF
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder /v1) O
I iNon-Layer
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Design Current
-apaci l;o
ILavers
Non -Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Ineef
Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes allo ❑ NA ❑ NE
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 JZJ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /CY
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
[3 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
m No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5D 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
0 NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[gf 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 [3 Application Outside of Approved Area
/ 12. Crop Type(s): � � Otv�Y d
,S 1-
13_ Soil Type(s): 9)4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 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 0 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 ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z 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 F;O.No
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 5` Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
kr 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 M No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/fnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes U, No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes .No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES.answers and/or any additional recommendations or.any,other.commentsT
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

t
Onsite Representative: 1 15 . . C i —
Certified Operator: : 9�
Back-up Operator:
type or visa: V uompuance inspection U taperanon xeview U notructure Evatuanon U ieennical assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: % Arrival Time: vv Departure Time: County: Region:
Farm Name: �Cc. T Q/`/"t ;%- Owner Email:
Owner Name: 7--C _4*AC `-- Phone:
Mailing Address:
Physical Address:
Facility Contact: C �� J�/'O J�CY� - _ Title: 0LLJkf Phone:
Integrator: 'Ov
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Desi n Current g
Desrgn Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity P.<op.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Feeder to Finish
&ev
Non -La er
f -
DairyCalf
DairyHeifer
Farrow to Wean
Design Carr nt
D Cow
Farrow to Feeder
D . P,o_ult ,
Ca acrty� Po .
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
I Beef Feeder
Beef Brood Cow
Other,.
;
Turkey Poults
L_jOther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Gg-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
❑ Yes
(, No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
rta -Yes
❑ No
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[3 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): Ile
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
6=kNo
❑ 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
El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�g_No
[] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P�jNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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): Ac�Scs�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gNo ❑ 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 No ❑ NA ❑ NE
Required Records & Documents
I9. 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 EK[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

. Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo
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 [a No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes ® No
and report mortality rates that were higber than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Eg No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes LR No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes gNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to gnestion:#): Explain any YES -answers and/or auy additional recommendations or any other commen#s ,
Use drawmo-oi facility to better eiplain situations (use additional pales as necessary).
iia�s 7�u p �t�.h�-cs B -s�� v�y �* "P""
AJD
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

iypc or visa: %5*n.ompnance inspecrion v uperanon meview Lj wrrucrure r.vaivauon v recnmcai tLssistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: rpp Departure Time: 7 County:
Farm Name: C, Lryyt 2- Owner Email:
Owner Name: �� }� _ Phone:
Mailing Address:
Region: 1--7V
Physical Address:
Facility Contact: 4fh S l �l � 7-r Title: Phone:
Onsite Representative: / Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current �'� ;Design Current Design Current
Swine
Capacity Pop. Wet Foultry��' � Capacity Pap. Cattle Capacity Pog.
Wean to Finish
La er Da' Cow
can to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
=" Da' Heifer
Farrow to Wean
I.
Design Current Cow
Farrow to Feeder
Ca aci RIP.... Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
BfBood Cow
Boars
pNon-Layers
Other
oults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
SNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE'
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): /91-
Observed Freeboard (in): ��
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
® No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes ® No ❑ 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 S No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes .® No ❑ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes j. No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IQ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [-]Yes EFINo ❑ 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): A,,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Ycs (ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of property operating waste application equipment?
❑ Yes rNo ❑ NA ❑ NE
❑ Yes E-No ❑ NA ❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F?SNo ❑ 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 [2k10 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L4,2:�_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 -

Facility Number: - Date of Ins ection: A23— /33
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Co 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V171 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
K 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
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Eq No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
- allo
❑ NA
❑ NE
Comments (refer to question #)• p . Explain. any YES answers and/or any additional recommendations or any other comments
Use drewiti s of facility to better eizplain situahons'(use additional Mims as necessarv).
70 � i• �o � !r(J���-�-' Coy%
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
use a J-77 W I d-�T Rx -)-
Phone: �f0�
Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: O� Departure Time: p ; County:
Farm Name:Owner Email:
Owner Name: e .s �[Y/ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: C 41_ 4�A� Title: Phone:
Onsite Representative: . 4_ Integrator:
Certified Operator: Sew-__ Certification Number: 9911/1120101'
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design
C►►apacity
Pop.
1esign
Wet Poultry Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
iry Cow
iry Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Non -La er
490
Layers
Design
Current
Non -Layers
Pullets
Boars
Other
Other
113eef Brood Cow
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
0 Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
❑ Yes ELNo
[:]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

' Facility Number: - Date of Inspection:
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UR- 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
[yINo
❑ 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
Vg 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
5a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, 7_n, 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): �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
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®, No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
❑ Yes
[ o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑. No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall
Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[f, No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2jNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

' Facility Number: 9 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Mt No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
KNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 allo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Expi..ain any;.YES answers and/or any addi.tional.�recommendations or any othertcomments",I
Use drawings' of facility to better ex lain situations use additionalpages_as necessa�'
/j/g�z-. � � [--cr/�ls ��-1r ; .-� ,�r �r�-%�. � C'>�►i%j r`GK /%T4iyiS ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-33D-4
Date:Q•-D�/�.Z
21412011

Type of Visit (9-ft—mpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �-% Arrival Time: i / o_J Departure Time: 0 County: Wkia&a- Region:
Farm Name: C )Ciz/rK Owner Email:
Owner Name: ���� S �C.lt Phone:
Mailing Address:
Physical Address:
Facility Contact: _ e—' 4 Ar4 s�/C�.T Title: of- Phone No:
Onsite Representative: __ S Integrator:
Certified Operator: Operator Certification Number:l�-C1
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 0 6f Longitude: = ° = I Q u
Di entmililill Design' Current
Design Eurreat
Swine Capacity Population Wet Poultry C p ciity Population
Cattle
Capacity Poputafion
❑ Wean inish
❑ La er
❑ DairyCow
❑ DairyCalf
❑ Wean eeder
ito
Od
rJ
❑Nan -La er
FeederFinish❑Dai
Heifer
❑ Cow
Farrow Wean Dry PouIEZ }
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
Gilts Non -La ers
❑Beef Feeder
EBoars ❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other. ❑ TurkeyPoults
❑ 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
[0-No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Date of Inspection
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ 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
UNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN [3PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) �3Ylrn ��t
13. Soil type(s) —(, id w _
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
S No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
iff Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[NNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B-No
❑ NA ❑ NE
;s : ! ! u H ort•-,r /�c'� r�r:/ ��z�rifl�Ao.
Reviewer/inspector Name 1 % Phone: p V. 3 a�
Reviewer/Inspector Signature: Date: 3 —, 3 f --- �f
Page 2 of 3 12128104 Continued

Facility Number: q'— Date of Inspection
` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [21No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 19Yes ❑ 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
[RINo
❑ 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
6a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EKNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9[No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Olo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5LNo
❑ NA
❑ NE
p yr� J�xrO
War �•t �O u r �3�rfyrt�e{a
�S �L�,T�or /`�-frr-�a
�u� G(1 u 7P•
�d n- 0�_ 441
4_3 6 v c.�S��� �`r.. 13z►/�yt C
Page 3 of 3 12128104

b {"1i
u
Type of Visit 1&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: w Arrival Time: Departure Time: County: - Region:FRP
_
Farm Name: ac„a- _ Owner Email:
Owner Name: ac -- ��'^ _ Phone:
Mailing Address:
Physical Address:t
t� l,
Facility Contact: 1') Title: H Qnaaf r' A Phone No: `-7 4 433 M
Onsite Representz 've� _ Integrator:
b S ICE r
Certified Operator: /' Operator Certification Number:
aP-A 0 Ic M 15 r
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = I [=1 tl Longitude: = o = I = N
Design
C►urrent
Design Current
Design Current
Swine Capacity
Population
_ W t Poultr}Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
, +1
00
Non -La er
❑ Dairy Calf
❑ Feeder to Finish
' ' -
❑ Dairy Heifer
❑ Farrow to Wean
D Poult �' =
r?
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
❑ Turkeys
-
Other R, >
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
a
9 ,_
Discharges & Stream Impacts
. Is any discharge observed from any part'of the operation?
❑ Yes [SNo ❑ 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
[,RNo
❑ NA
❑ NE
other than from a discharge'?
12128104 Continued

Facility Number: — 3 Date of Inspection IY
rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes !RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5� 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 E'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 13 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t' No ❑ NA ❑ NE
maintenance/improvement?
IL 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 > l 0% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Lj Yes
D¢No
LI NA
LI NE
15. Does the receiving crop and/or land application site need improvement?
es
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ERNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
CR-No
❑ NA
❑ NE
Comments (refer to question #) Explain;any YES'answers and/or any recommends#ious or any other3comments.
Use drahln s'of facili to better ex fain situations. use a`dd�tional a essas:necessa_.�
ty P { g. r}i)
�.-.. ,�. '.. .. _ .' .. . 5,a-,. N. fit
ReviewerllnspectorName
Phone:
t�Q..
Reviewer/Inspector Signature:
Date: NA -a a o
Page 2 of 3 v 12128104 Continued

Facility Number: —jar— Date of Inspection ! 7
euuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [SNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 CAW MP?
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? (iel 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
rRNo
❑ NA
❑ NE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
87No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
N,NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
fRNo
❑ NA
❑ NE
❑ Yes
I'No
❑ NA
❑ NE
❑ Yes
BNNo
❑ NA
❑ NE
❑ Yes
P'No
❑ NA
❑ NE
�. o r * q x -
Add�t�onai Comments and/or4Drai ngs .,, F
ay 4�rG9 V br*o-, 0C� vcr± 5 i:rv� ✓, dove. N&NUO&C nof_ kP-:
if soil t .9
'c
ev_v, d,cwn I DaoL of e a2 t)w,fnA
`�
C�1Jcd_ r-ecads,
L-P I C -eo(ni r
- 4belar� '
�dlfiraa I nag, nab` a) �cow� cn�y a ba�P,�
Cwhfhche-ckf 100' p�4�.s s
haY c� e abo�� lv�� 4np abor a000J
� ter J �( Ac�,�.�,�r� s hold fie_ 1r4fd rib 01 n�fi����a-i•
�3 sa►�P-) S'6m J
Page 3 of 3 12128104

+ facility r No. Farm Name .J C— Date
_
Permit CO OIC_ NPDES (Rainbreaker PLAT Annual Cert)
—.'
KIT
C UC
Drops 10
t•
s
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
Sludge Depth (ft),
?I
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
1 i'�/i=m•�i�uoli 111. �f�/�A 1n.n .51 u�,o�'..i.w 6_/�lArn111va1�'.,n
lop - • .
------�-
MuguM-12•
--------
Design Width
--------
Soil Test Date Zv Q��n RQ1P!)�) Wettable Acres _� RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records
Lime Applied 1 in Inspections ✓
Cu-I Zn-I 120 min Insp.
Needs P Weather Codes bbl`
CMD Yipld �h Transfar �hPPtC
Waste Analvsis Date
• 1 1 1 .
�����
i_tsias..o.�
a � . ���
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
s
Verify PHONE NUMB RS and affiliations j j)
Date last WUP FRO IYS1OS Date last WUP at farm �� �%10 g' App. Hardware -��i0*�`-;r+dq
-{i��,oay 1 Qv s a I
FRO or Farm Records / / Ws -
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Ib/ac
.#'a-11 z
aaaaVV 4 p 1 5q_ j 40
a 1adoq iJc'r S 1,00. _ k i

131MS . A S -r 5-ze07 1*-
U Division of Water Quality
Facility Number r35 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 12= D 1 County: 06 d1e0`1 Region: l
Farm Name: • a-• C • S{i° g" S Z Owner Email:
Owner Name: 3 • C ­
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = c E--] ' = " Longitude: = ° = ' ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder 2 660 2,56D
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
4❑ Other
❑ Layer
❑ on -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system`? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CI'No ❑ NA ❑ NE
❑ Yes ❑ No Eff NNA
❑ NE
❑ Yes ❑ No LR NA
❑ NE
❑ Yes ❑ No LI NA
❑ NE
❑ Yes El ' -No ❑ NA
❑ NE
❑ Yes [ No ❑ NA
❑ NE
12128104 Continued

,L
Facility Number: �cj -135
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ,V�'No [I NA ❑ NE
❑ Yes LS No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): ! ,
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tthh at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L'1 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 [J"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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. Croptype(s) 'B��
ncv (/Cry t iiAy a✓ GraiGd
13. Soil type(s) A v lo A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes Cl No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes Io ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [E N-o El NA ❑ NE
El Yes CWo❑ NA [I NE
��f+« CpM►.ca�.-fps Y F*'ti/i !� It- �`/-75-1 c-Jlri-c4 a11c"O expA19 4+ W,n s r,,kwt e-S 6LIWI a
Cym /-.ram- C9tr16_�
Reviiewer/]nspectorName G;jGrf Phone: �/,O �33333�
Reviewer/Inspector Signature: Date:
Wage 2 of s IL1Z61U4 "nunuea

ti
Facility Number: 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Pfo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �Vo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �. 10 ❑ 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
ETNo
❑l NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
EI NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3'glo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[<o
❑ NA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
A
B NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJ, NNo
[I NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
Ls ivo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
3No
❑ 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
B o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��,,//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
LSNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L7No
❑ NA
❑ NE
Comments andlor Drawings:
12128104

T_U_S�
Type of Visit (Mmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %~IS-o$ Arrival Time: Departure Time: County: 8f4dG.✓ Region: �2O
Farm Name: + C = S40 Owner Email-
Owner Name: J ' C Phone:
Mailing Address:
Physical Address:
Facility Contact: 3. C = S404e-c v Title: 49CJOU rr Phone No:
Onsite Representative: I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 o=1' 0 Longitude: =° 0 f 0"
Swine
Design C�rre.nt
Capac�tyP p lation
Design Current
Wet Poultry Capacity P pulationCattle
Layer ❑ Dairy Cow
Design Current
Capacity Population
❑ Wean to Finish
10
ean to Feeder
Zoo
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
LOU Dry ltry.
❑ Layers
❑ Non -Layers
❑ Pullets
El Turkeys
❑ Turkey Poults
❑Other
5 ; ❑ DairyHeifer
nm ❑ D Cow
t
� Non -Dairy
El Beef Stocker
El Beef Feeder
❑Beef Brood Co
Mumber of Structures:
El Farrow to Wean
❑ Farrow to Feeder
}
El Farrow to Finish
i
❑ Gilts
❑ Boars
Other a s =.
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E3- o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Mo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
QNo
❑ 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)
El Yes
,�/
LK No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CyNNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L' No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r.�.
Facility Number: 0 9 - %, J Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
3'1 o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
2110
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 K
r�
Observed Freeboard (in): Z 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ffN
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[j'%o_
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
N/o
El NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1
E? o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,��
LSNo
❑ NA ❑ NE
maintenance or improvement?
.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
���
D No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,�
LNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N"o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej--N".
[3 NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
31 o
❑ NA
❑ NE
Reviewer/inspector Name Phone: '9/40• V33.3330
Reviewer/inspector Signature: Date: 7 -/S--2UP0g
Page 2 of 3 12128104 Continued

Facility Number: Q q--;3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eilqo' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0'iq-6- ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes aN-o- ❑ 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�0�
[� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
3-15o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-lq'o--
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Elgo❑
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
ElLT
1vo—❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.�
C,o❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
,
L 3 o
❑ 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
,.,�
El
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�,�
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,�
[3-<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[}<0___11 NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number l S Division of Soil and Water Conservation
- - In Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Structure Evaluation t� Technical Assistance
Reason for Visit
� 0 RoRouutine 0 Complaint 0 Follow up 0 Referral 0 Emergency ther ❑ Denied Access
Date of Visit: L�'-i ti_ ly t 1 Arrival Time: t �7Departure Time: 2 County: Region:
Farm Name: "'r1 "���_ . "Oi � VCky wxy Owner Email:
Owner Name: '�U Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No: M
Integrator: ` ! 1--b
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
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
Latitude: = o = 6 Longitude: = o = 1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullcts
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FFI,
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 MNo ❑ NA ❑ NE
❑ Yes
❑ No NA
❑ NE
❑Yews
❑No NA
❑NE
❑ NoA,NA
❑ NE
❑ Yes
❑ Yes
ONo ❑ NA
❑ NE
❑Yes
❑NoN�NA
El NE
12128104 Continued

r�
s Division of Water Quality
aciiity Number S O Division of Soil and Water. Conservation
Q Other Agency
Type of Visit Q Compliance Inspection 0 Operation Review )j Structure Evaluation O Technical Assistance
Reason for Visit O Ro-utine o Complaint O Follow up O Referral 0 Emergency Other ❑ Denied Access
Date of Visit: ��-] jv t j Arrival Time: M77Departure Time: 2 (}D County: h Region:
Farm Name:a �`6 uA V 'm Owner Email:
Owner Name: `-!+� �1<e�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: Ph
Onsite Representative: Integrator: ' I ' —b
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 = 0 « Longitude: = ° K
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ _ _ 1 ❑ Layer
1 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
E]Dry Cow
E]Non-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E I
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 MNo ❑ NA ❑ NE
El Yes
El No MNA
El NE
❑ Yes
❑ No ;9 NA
❑ NE
❑ No>4aNA
❑ NE
❑ Yes
❑ Yes
RjNo El NA
❑ NE
❑ Yes
❑ No YJ NA
❑ NE
12128104 Continued

Facility Number: pf� — t! Date of Inspection 3
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 J9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I
Spillway?:
Designed LI
Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integr4 of any of the structures observed?
❑ Yes [�No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
! _
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No ❑ NA NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA [a NE
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)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Aapiication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA NE
El Yes El No ❑NA �NE
❑ Yes ❑ No ❑ NA
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
�NE
NE
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
PE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
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
N)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):
6� faz 4 nuLk !ter
Reviewer/Inspector Name Q Phone-
Reviewer/Inspector Signature: Date:
12128104 Continued

9
Facility I tuber: p� — Date of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
i
Designed Freeboard (in):
Observed Freeboard (in): 19
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ ;No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA [ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA R NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
❑ No ❑ NA N)✓
(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
El Yes
El No El NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA [ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA NE ;
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
'
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA E
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA [�*E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑No ❑ NA ONE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA g3NE
18. Is there a lack of properly operating waste application equipment.
El Yes
❑ No ❑ NA
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):
�ca"d 6Ck
�us-J �w 1 0_'3
q ` ► l CLA
ReviewerlInspector Name 7'd } Et
Phone:
Reviewer/Inspector Signature:
Date:
12128104
Continued

Facility Number: Q Date of Inspection l '-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ❑ No ❑ NA ERNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA P 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
❑ No
❑ NA
VbNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
0 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
IPNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[P NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
Comments and/or Drawings:
12128104

EgciGiy Number:a -{ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA q NE
the appropirate box. ❑ WUp ❑ Checklists Design ❑ Maps
❑ Desi p 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
❑ No
❑ NA
ONE
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
0 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
9NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
rm NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
M NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
19 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
h NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
NNE
33. Does facility require a follow-up visit by same agency?
ElYes
ElNo
ElNA
N NE
Additional. Comments and/or Drawings:
12128104

E.A,�t b.7 l2R Z -13-V 7
4
0 Division of Water Quality
Facility Number Q / 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: b Z 9 -O% Arrival Time: Departure Time: Tr'OC County: ,Cal44�t� Region: Y/'�9
Farm Name: w Z Owner Email:
Owner Name: _ W } CL r7C- %jM 5tre+� Phone:
Mailing Address:
Physical Address:
Facility Contact: bcd e- M ea c-ir_ _ Title: Phone No: 910 - g7'Z . 90gZ
Onsite Representative: Integrator: A ILA4(b I,.., R inwjr-1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 0g = Longitude: =10 ED
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
2 OQ ❑ Non -La ei
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation`?
Discharge originated at: El structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El
Dairy Cow
❑
Da' Calf
❑
Da Heifej
❑
D Cow
El
Non-Dairy
El
Beef Stockei
El
Beef Feeder
El
Beef Brood Co
Number of Structures: ILI
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 [A No ❑ NA ❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
GgNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[M No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: O q— %3S Date of Inspection 6 z9-07
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 [9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1� 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
nNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
[� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application of Area
OOutside
12. Crop type(s) G�w.+.�c� �+- 5:••.� L� C r I �.; �c �s e r5 tr.� !
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
I Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
O W /�i t�Y 4 1 Cr Li W d t'. rJ t p envy 4 ,v i rG
Reviewer/Inspector Name t2i C k­� R 4t_-j tj.& Phone: C`3t�) `Jt33 9300
Reviewer/1 n Spector Signature: Date: & — Z 0 0 7
12128104 Continued

5
Facility Number: OGf —/3S Date of Inspection 6-29-07
s
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eff 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 El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P@ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility'fail to notify the regional office of emergency situations as required by
❑ Yes
[9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[A No
❑ NA
❑ NE
12128104

Type of Visit rV Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit @ Routine Q Complaint O Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: D3:30 County: 01ado•v Region: �2d
Farm Name: + Lve rav Z- Owner Email:
Owner Name: 1%gjQ Phone:
Mailing Address: _ C C bal er 64 e_ 14 y (P— PQ g Z-3 16-h w .,.l A/ C. -zV37
Physical Address:
Facility Contact: >4e_ M cA4 a v--- Title: AAAPia a✓ 0 L
`' Phone No:
Onsite Representative: (�- JV t t lut Integrator: ► t-4
Certified Operator: 4 G- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = u Longitude: = o = 1 = L
Swine
❑ Wean to Finish
11.1
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dai Cow
Wean to Feeder
Z(v00 Z,
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish`
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
:ea-
�- , ❑Dai Heifer
t ❑ D Cow
Dry Itry_ ,
k' ❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Co
Number of SUuctures: a
❑ Gilts❑
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ "furke s
❑ "furke Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
To No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
PNo
❑ 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
EpNo
❑ 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
I2/28/04
Continued

I
Facility Number: D c% — f 3 5 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
❑ Yes [jq No ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[C[ 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
��qq
Ld 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
[M 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
UNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3fNo
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[2No
❑ 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) D �'-�• �l ti d :` r /� t' . S,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CNo
❑ NA ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M 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
[WNo
❑ NA ❑ NE
A
Comnments (refer to question #}: Explain any YES answers and/or any'rec, 01ommendations or any other Comments s'
Use drawings of facility to'better explain situations. (use additional pages'as%necessary): rY
-,
N0 2oe)6 . (ter . Dal. Meye•✓
i'S f►M4,v,ef01_
a pVa o i• My . Wlcy�✓ : a #f Ut. Y 4�Ji �a� old ,.acS Ir r (c.s {isv csnr�
1r L
AJe�ed C; !►gel-h`•�vS. At,- Mi�cr W,tl IMa% NGet1�d coYrt-c-A"I tj cl,6-e"j rs
(.: 04 tu4',j CST 7 v 67+ � iy,t V - AA t-1 C-✓ LA-
i
110 ►':j' f IGi�iiF
__1
ITC-6✓� 1 /7-r-�rs rt'P1/ �L �Z., t'C✓�.,,�s •
7
Review er/InspectorName �R; �e��,.(S
1 Phone: 010) 43-�-3330
Reviewer/inspector Signature:
Date: / Z - Z o - 2004
Page 2 of 3 12128104 Conhfnued

i
Facility Number: O q —135 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
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
E�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�PNo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[? No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[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
[YNo
❑ 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
[2 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
[ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Additional:Comments and/or Drawings: <y
.r . .
Page 3 of 3 12128104

Division of Water Quality
acrlity Number c7 l �/ 3ST O Division of Soil aad `Vater Conservation
Q Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 11-43 -O Arrival Time: Departure Time: County: ,<G��.✓
Farm Name: h h / f—k t'" # Z Owner Email:
Owner Name: � e �. „ L� i Y „ Phone:
Mailing Address:
Physical Address:
Facility Contact: o b ` IrC.y� _ Title: Phone No:
Onsite Representative:
Integrator:
Region:
Certified Operator: B> c, b B 010 4- Operator Certification Number: / ( Z 730
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 a = Longitude: ❑ ° = . ❑
Design Current Design Current Design Current -
Swine Capacity Population Wet Poultry Capacity .Population Cattle Capacity Population
❑ Wean to Finish
® Wean to Feeder :Zo & 0 Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other .
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other I I-- -
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'?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockez
l
❑ Beef Feeder
❑ Beef Brood Co
I
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 ® No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑Yes
No
❑NA
El NE
[:]Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — i3 y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [VNo ❑ 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 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 ® 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
Z 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/improvement?
]1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
X No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) &_Vr"� —�_ k4% tra frs S' S ft�ua..(..l to " ,' i
13. Soil type(s) gx A
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
[9 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination's
[] Yes
LM No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J@ No
❑ NA ❑ NE
lain: anv
Reviewer/Inspector Name Iu1�L e.zf Q:fs �o ' ' Phone: Nty
Reviewer/inspector Signature: P1+�t,�� Date: //�03 — 0S
12128104 Continued

Facility Number: & 9 -_ . Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;N No ❑ NA ❑ NE
the appropirate box.
❑ WUP El 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
® 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
EN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
12128104

-7 ocf " C�0 C
Facility Number Q S — 13 Date o-3 D S—
Name Bolo.
Farm Name E i i to R& " -z--
C.O.C. ✓ permitted on nand
Waste plan Soil Test PLAT Deep Soil test
Soil type
Crop types
Designed Freeboard 19 Observed Freeboard
Rain gauge Rain breakers Daily Rainfall
Calibration of spray equipment G.P.M.
Sludge Survey Crop Yield 120 minute inspections _
1 in. rain inspections Weather code Weekly Freeboard
Waste Transfers Waste Analysis
Pumping time
Waste Analysis % & Month
Comments:

Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
(Reason for Visit 0 Routine Q Complaint O Follow up Q Emergency Notification O Outer ❑ Denied Access
7 Facility Ntmiber Date of Visit: ii l l Z 0 Time: 1 70 = 00
C Not Operational Q Below Threshold
© Permitted 0 Certified Q Conditionatly Certified 0 Registered Date Last Operated orr Above Threshold:
m FarName: — g![Lr4� RP" -v -4* 2.. Coanto: s l -- -
Owner Name: _.& (o & t � Phone No: . „ �I d �a Y 191 -19-
117atiing Address: % S ou:]� —�_. _ _ CCOL.r
Facility Contact: .._->ap __l Title: Phone No:
Onsite Representative: ( Integrator: Certified Operator: --so 0 - - --- 6,c-ei Operator Certification Number.
Location of Farm: L
PdSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' u Longitude • '
Discharses & StreamImpacts
1. Is any discharge observed from any part of the operation? ❑ Yes EZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance matt -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes %No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 21 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3
Identifier: —_ l _- _._...
❑ Spillway ❑ Yes gLNo
Structure 4 Structure 5 Structure 6
Freeboard (inches):
12112103 Continued

Facility Number: - t3S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes CKNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes No
closure plan? .
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ¢j No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [( Yes Jallo
elevation markings?
Waste Aau[ication
10. Are there any buffers that need maintenance!unprovement?
❑ Yes
RNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
J&No
❑ Excessive Pounding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (5e-rvvi V j-&- WL&a � v`
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
EJ�No
b) Does the facility need a wettable acre determination?
❑ Yes
[KNo
c) This facility is pended for a wettable acre deterrination?
❑ Yes
SkNo
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
UT -,No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 KNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Wo
roads, building structure, andlor 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 &No
Air Quality representative immediately.
❑ Final Notes
Se,-,-w A-*- Ntar - ot,+
S"u-u- C,t.r ti 5�} - Apr
--. PleL. wti w a-r`� -r(.� ed4p,5 O� 1"t4- 1gt 0-Qs- as, Soo-,, o's
y G u r'C Q
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Q
12112103
Continued

Facility Number: 41_ Date of Inspection
Required Records & Documents
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!heckUsg,'desigw,-mt , etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Applicati[fiee❑ Freeboail� ❑ Waste Analys4g-'❑ Soil SamplitV'
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/Inspector fail to discuss review/inspection 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 AAW?
NPDES Permitted Facilities
❑ Yes EgNo
❑ Yes
4 No
❑ Yes
dNo
❑ Yes
${ No
❑ Yes
No
❑ Yes
ER No
❑ Yes
® No
❑ Yes
KNo
❑ Yes
jRLNo
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes El No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfak-16 Inspection After l " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

i
s a Lr" d _"�• 7 -n• `4 3, ; _ sr -:. - nf, '-3 �, - �. C "y< 3. `_ S* Yti t.!� v �"�'� •" 4 -`y; r.
,Division of WaQuaLty x s
ter_ z� � a.. e aC r • � �' 3.:r•* : � e .N -�-' a °acFr
ti �"� " x O Divtstou of SotE and Water Coaservatton
,
Agenc. '.! _�
tF`'.'3';L ..r",..,_ . _ s..--..-� r r�'.a"c.*=t7Z �" �,;�. ,'a;�x`,1+:.•'�":. * i'n<L�S-y.. .--
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint ® Follow up p Emergency Notification O Other ❑ Denied Access
Facility Number 49 135 Date of Visit: 3/22/2004 'rime: 11:00
O Not Operational 0 Below Threshold
® Permitted ® Certified [3 Conditionally Certified [] Registered Date last Operated or Above Threshold: ........................
Farm Name: bilb[a y-FarlmAZ............................. County: 131adea ............................................... FRO...-----....
Owner Name: 130b .......................................... Balhriey................ .------------------------------------ Phone No: 9.- 4 i4....
--------------------
Mailing Address: 6.$7..()ld.TjUM.Aid.................................. ..... Clarkloq.N.0 ............................... ... MID
FacilityContact. ..................... .......... Title: ................. ----------------------------------------------- Phone No: ..-------------•-----------------..----------------
Onsite Representative: B.9h.7>DAlbrtry..................... ... Integrator: M.u1CV4..l jImjly..F.#K l&................... .....
.............
Certified Operator:$Q)t2.......................................... $i1brey.............................................. Operator Certification Number: 1OZ73 .............................
Location of Farm:
3R 1777 +
® Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude 34 0 32 U4 Longitude 78 35 1 ©4
De_ sign Current . Design Current ' Design ,_ Current -
Swine. Ca achy Po ulalioit . Poultry.;;. CaAacft ° Potpulation Cattle ; , 'Capacity 'PoPalation,
® Wean to Feeder
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made:?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. Ifdischarge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify I)WQ)
2. Is there evidence of 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'?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
................. .... ............. .................................... ................. .................. ........................ ............ ............ I-- ..... 1-............ ....................................
Freeboard(inches): ...............32......... ........... .... .....-...--...---•-...................-----..................................... ....................-------- ....................
...... .
12/12/113 C'nn�inr�ed

Facility Number: 09—t3g Date of inspection 3/22/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
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
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor lssues
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 hoots? ❑ 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 ❑ No
Air Quality representative immediately_
,Use drawings of facilityto better explaip situations�(use addidona! pages as necessary): ® Field
Farm visited as part of follow-up to a self reported high freeboard. Lagoon is now back in compliance.
Final Notes
?: 1 -,A-
Reviewer/Inspector Name Larry Baxley Mark'Brantely
Reviewer/Inspector Signature: Date:

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q Other
/Jr
� Y
.mac �-.+�.-�-' i �:_.•
❑ Denied Access
Facility Number 09 135 Date of Visit: 2/27/2004 Time: 9:30
0 Not O erational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified © Registered pate Last Operated or Above Threshold: ...........
Farm Name: �Ibr �:. a1n[nt. ....................................................................................... .... County:Bladea ............................................... FRO .............
Owner Name: Bob ........................................... B.ilbra........................ .------------------------------- Phone No: 9.1l1:. 5.720M...----.........----------•
Mailing Address: bS.z.. ?1ti MM.Rd..................................................................... .......... C'jairjktajt'x.C......................................................._. 2.433............
FacilityContact: ------- ---------------------------------------------------------------------- Title: ----------------_----_ ...... ...-..---------------- Phone No: ....................................... ............
Onsite Representative: _...................................... ..... Integrator: fy,�Urphy..Famjjy-.Farms.....................................
........................................................................... .....................
Certified Operator: .U.Qkt.......................................... Bub.rep:............................................. Operator Certification Number: 16272.............................
Location of Farm:
31111777 +
® Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude 34 • 32 04 Longitude 7$ ' 35 ° 00
t ;' De'stgn Curren
Swine - Cs act �Po :uiatii
IN Wean to Feeder
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boats
Discharges & Stream Impacts
1 • Is any discharge observed from any part of the operation'? ❑ Yes ® No
Discharge originated at, ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify ❑WQ)
2. is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
'*Vaste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; 7Q"
Freeboard(inches) : .............. ........... ................... ........................
12112103 t"antinued

Facility Number: 09-135 Date of Inspection 2/27/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
[]Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
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 ❑ No
16. is there a lack of adequate waste application equipment'? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is 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 ❑ No
Air Quality representative immediately.
Comments (refer to question' Explain any YES answers and/or arty recomtrtendahoris or any otlhe'r.comments r rx� �r� r - r
Use draivingsyof facrhty#v better explarn srhiahoris (rise addrtional pages as necessary) ` ®Field Copy El Final Notesx
- F'°L is l 1 :i•
T .. 4:
Farm visited after Mr. I3ilbrey had called in his other farm, ( 09-75 ). This farm Mr. Bilbrey stated he believed the stake is off and FRO
staffagree. The lagoon wall near one corner had freshly added soil on it. At this spot it appeared the liquid level was much higher than
the marker indicated.
Reviewer/inspector Name Larry Baxley Marlc•13rantely' Richard Cannady
Reviewer/Inspector Signature: Date:

Division of Environmental Management o9 -i 3s
Animal Feedlot Operations Site Visitation Record D 9 - 7S
- �„�--
Time: /?,' Ti
fincra1 Information;
Farm S �carc Cis [�1u Gatmty: a�
Owns Nattte: � � No• --Sb y
On Site Representative: of �LAA� K _ l nc,r- Integrator.
Malling Address:
Physical AddresA=ati i
Latitude• I 1 Longitude:
Oneratian De
icapti2n: (based on design characterhtta)
-
7ype of Swint No. of Animals Type of PoWtry No. of Anbrials
Type of Carle
No. of Hula
0 sow El Ilya
D Dairy
pw=ery mar=m 00 0 Non -Layer
O Beef
O Food=
OdierType of 1lwsmek Number of Animals:
Number of Lagoons: (ineJude in the Drawings and Observations the f veboard of each lagoon)
FadIity Ingpectione
Lagoon
_
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Yes 0
N04
Is seepage observed from the lagoon?:
Yes ❑
No U
Is erosion observed?:
Yes D
NOW
Is any discharge observed?
Yes 0
No,1►
O Man•mode D Not Man-made
Cover Crop
Does the facility need more acreage for spraying?: Yes ❑ No
Does the cover crop nerd improvement?: Yes 0 . No'A
( list du craps which ed ienprav eneesrj
Ckop type: Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application? Yes 0 No(GE
Is a well located within IOO fret of waste application? Yes 0. vq):!R
Is attiunal waste stockpiled within 100 feet of USOS Blue Line Stream? Yes 0 Now
'Is animal waste land applied of spray irrigated within 25 feet of Blue Line Strom? Yes 0 No Q
AOI — January 17JM

Maxnte�te
Does the facility maintenance need improved? Yes 0 NOW
Is there evidence of past discharge from any part of the operation? Yes 0 No O
Does record keeping need improvement? Yes 4 No AP
Did the facility fail to have a copy of the Animal waste Management Plan on sine? Yes D No*
Explain any Yes
Signatt=. Date:
cc -F=fihy Auewnew Unit Use Anadowna if Needed
DrawisIgs or Observations:'
ji
LZ
b s,
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AOI — Tanusa717,19%