090190_INSPECTIONS_20171231

_. .. - ___--�.�.--.- .-_ _-+..tom."..-. + -+ .% :/._ .. r. __-�-� ++v.. .s. •--• _ �. '�. v.�'r.«. ! �-Q`-+�- � �_� r..+__�—T-.-..-...,_,.-.
ivision oi'Wa'ter Resources
aciiify Number - ® © Division of Small and Water Conservation
Q
He Agen
D of Visit: ompliancc Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
ion for Visit:0-90--u—tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:rArrival Time: Departure Time: ,ria County: Region:
Farm Name: //F�tiy j yL Yf�l�t_/"�rry Owner Email:
Owner Name: y�Q� S1iJi��p r� %1%f�, Phone:
Mailing Address:
Physical Address:
Facility Contact: Q W/- Title: Phone:
Ar
Onsite Representative: _ Integrator:t/�
Certified Operator: �.Y �y; , Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 io ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes al o
❑ Yes 0 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑N
❑NA ❑N
Page 1 of 3 2/4/2015 Continued
Design Current��
Design CurrentDesign
Current
Swine
Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
gw
on -La er
lEi
Dairy Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D : Pout 6Cie acr _' P,o .
Non -Dairy
Farrow to Finish
Non -Lavers
Pullets
Turkeys
I 113eef Stocker
Beef Feeder
Beef Brood Cow
:a
Gilts
Boars
C?ther
Turkey Poults
Other
tl&IG N .,GlI:
nl:
-
L_L(2Lher
:iubk":II,xuesl.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes io ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes al o
❑ Yes 0 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑N
❑NA ❑N
Page 1 of 3 2/4/2015 Continued

'[Facility Number: _ D JDate of Inspection:
1% Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B N ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [<lo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
�o
❑ NA
❑ NE
waste management or closure plan?
[DNA
❑ NE
❑ NA
❑ NE
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
2 --go
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
.❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D -No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
[::]Yes
[i]'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ 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):—a41_e Z�In-1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E; -No ❑ NA ❑ NE
15. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes B -No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes
No
❑ NA
❑ NE
[:]Yes
�o
[DNA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[3 -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, 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
[2�No
❑ NA
.❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
e^No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
Page 2 of 3 2/412015 Continued

'[Facility Number: _ j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? F]Yes [T No ❑ NA E] NE
I� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'qo ❑ 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 Ea<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ 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 Reviewertinspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes E3-lgo ❑ NA ❑ NE
❑ Yes 0'14-o ❑ NA ❑ NE
❑ Yes O'1Go ❑ NA ❑ NE
❑ Yes [ - o
❑ Yes [�J1 o
❑ Yes Ef qo
E] NA ❑NE
❑NA ❑NE
❑NA ❑NE
Cmrnents (refer to questtonj#) Explain anyl'ES answers sndlorany additional recoinmendstrons or any ofher�co6mments:
U. drawings of facility;to. better explain-situatiaps;(W additional pages. as necessary).
se=r
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �� �djd'
2/4/2015

3-t- t -ziu vTJ �O/� FC - Dozz4
Type of Visit: (D�Compl1 nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: - -1 7 Arrival Time: J Departure Time: 7 -.2-K County: Region:
Farm Name: f' rt Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: , dty,� r- Title: Phone:
Onsite Representative: Integrator:
Certified Operator:t� w� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current , Design Current
Swine Capacity P,op. Wet Poultry Capacity op�� Cattle Capacity Pop.
Wean to Finish ILayer I _M„ Dai Cow
Wean to Feeder Non -La cr I Dai Calf
Feeder to Finish ���- ' �� Dairy Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder ©. P,oult , Ca aeity 'P; Non -Dai
Farrow to Finish La ers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Caw
• Turkeys,
Other
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation'? ❑ Yes ®moo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 2 -No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
�f 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):
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.)
allo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes S No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
0 No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses ars immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
n No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CaNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
19_ Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
❑ Yes
0 No
Waste Application
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑-No ❑ NA
❑ 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/oaf Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0670 rt.
13. Soil Type(s): AFT,
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M 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 & Pen -nit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 i. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking p Crop Yield ❑ 120 Minute inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[:INA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
l
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JZ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E[No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ®No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B No
D NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�J-No
❑ NA
❑ NE
lComments (refer,,to question,#)Eiplain any YES answers _and/or any additional recommendations or -'any other comments..
UseArawinus of facilitv.to betterieulain:situations (use additionil Danes as necessarvl.'a'*`'
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: 91,9222-- D
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other /0 /Denied Access
K/W0I.-1
Date of Visit: /6 ! Arrival Time: ,'oo Departure Time: County: Region:
Farm Name: Lvy,` q urs Ply / �� Owner Email:
Owner Name:�,�, S/t/�%�j�•� Phone:
Mailing Address:
Physical Address:
Facility Contact: a ,I a- -/ Title: Phone:
Onsite Representative: Integrator: Jyy� , iJY
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharues and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes � No ❑ NA E] NE
[-]Yes ❑No
[-]Yes ❑No
❑ Yes [—]No
[:]Yes ® No
[-]Yes C3- No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
2/4/2014 Continued
Design
Current
Design
Current
Design Current
Capacity
Pop.
Wet Poultry
C*apacity
Pop.
Cattle Capacity Pap.
inish
Ito
rpFeeder
La er
Dai Cow
eeder
(�p�
Non -La er
Dai Calf
Finish
Dai Heifer
Farrow to Wean
Design
IDry Cow
Farrow to Feeder
K
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharues and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes � No ❑ NA E] NE
[-]Yes ❑No
[-]Yes ❑No
❑ Yes [—]No
[:]Yes ® No
[-]Yes C3- No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
2/4/2014 Continued

Facility Number: - ?O Date of inspection: 0T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Mn 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):
Observed Freeboard (in): 3 ��
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 property addressed and/or managed through a
❑ Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 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
2jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[a No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): ffl r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[S 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?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ei No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
RNo
❑ 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 [Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: �}—�-
24, Did the facility fail to calibrate waste application equipment as required by the permit? []Yes ® No
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E. 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 allo
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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes QjNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes [RNo
❑ Yes 0 No
❑ Yes a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Cominents (refer to question#) ;Explain any YrES aisswers and/or any addrt<onal recommendattous or any other comments. `
Use drawings_of_facmtyto iietter ezplain s�tuahons {use addrbonat pages. as necessary,)_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2/x'!3— -s3y,o
Date: !/— —
.Z,d2 //
2/4/2014

34 -15 -
Type of Visit: Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 'technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I aye—/ Arrival Time:!D ' Departure Time: County: A4y4 - Region:
Farm Name-' E,.�. d �7_3 Owner Email:
Owner Name- //'/ ii Phone:
Mailing Address:
Physical Address:
Facility Contact: ,r,y�Y�hKr-� Title: /yf.��" Phone:
Onsite Representative:
Certified Operator: m IZ41- —
Back-up Operator:
Location of Farm:
Integrator: - ,/7Zu ✓pw�
Certification Number:
Certification Number:
Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
CE,No
❑ NA
❑ NE
Design Current
❑ Yes
Design
Carrent
Design Current
Swine Capacity Pap.
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
can to Feeder 00 00
Non-Laye
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P.oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qttier
Turkey Poults
Other
Other
i
0
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
CE,No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
[:] NA
❑ NE
[:]Yes [] No
❑ Yes 0 No
Yes V] No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

Facility Number: Z7 - Q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes E. No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [DNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Jam"
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JH� 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
10 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E2�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): 4 'J20",_
13. Soil Type(s): S-- / `k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C, 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
SNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ 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
53 -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 M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [—]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [5�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes SNo ❑ 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 Eallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ," No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes R No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes [& No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes ®, No
[:]Yes [0 No
[:]Yes [5No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations_or any other comments Y
Use drawin s..of.faeili -to better explain situations use additional pages as necessary).* _ '
Reviewer/Inspector Name: s'�4s-�_ �TJ Phone:
s
Reviewer/Inspector Signature: _ Date: J�/r
Page 3 of 3 214/2011

Date of Visit: Arrival Time: Departure Time: / t) e? i7 County: 7U1VL..1 Region:
Farm Name: -� ` ►�, `N�r .� ¢� Owner Email:
Owner Name: ,O ` ry Phone:
Mailing Address:
Physical Address:
Facility Contact: 4�f�/ �y,T,4. r Title: t� _ Phone:
Onsite Representative: s��.—� Integrator: jirt/j�ip
-a
Certified Operator. t)7�'t YL fj; r.L Certification Number: f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
R'et Poultry Capacity Pop;
La er -
Design Carrent
CattleCapacity Pop.
Dairy Cow
Wean to Feeder
Q
Non -La er
a. Was the conveyance man-made?
Dairy Calf
Feeder to Finish
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Yes
F
Dairy Heifer
Farrow to Wean
c. What is the estimated volume that reached waters of the State (gallons)?
Design
Currents
Dry Cow
Farrow to Feeder
❑ No
❑ NA
Dry P:ou1
Ca aci
Po"''
'
Non-DaITY
Farrow to Finish
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Layers
® No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other_
Turkey Poultsx
Other
�`
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JR No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
C] 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
[2 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 1/412011 Continued

Facili Number: _/901 Date of Ins ection: `
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):
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.)
�No ❑NA 0 N
❑No ❑NA ❑NE
Structure 6
E] Yes ®No ❑NA ❑NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
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? 12-Yes�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fE[No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No DNA ❑ 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 [D Application Outside of Approved Area
12. Crop Type(s). — /7 ��s �6?rC r/�yr/� _;�1I1Az - le 0-1+ +-V
13. Soil Type(s)=
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M-1 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 [�a 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?
Reauired Records & Documents
❑ Yes (Z No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ 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 V 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
R No
❑ NA ❑ NE
Page 2 of 3
214/2011 Continued

Facility Number: _ Date of Inspection: `
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ® No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ® No NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ® No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes ® No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
M No
NA
E] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No
NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
® No
NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
© No
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Yes
® No
NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2 No
El NA
❑ NE
Comments (refer to question ftExplain any YES answers and/or any additional recommendations or any other comments;
Use drawings of facility to:better'egplain situations (use additional Oakes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %6?"gJ3 -7-7 a n
Date: oiy
2/412011

It
ivi5-ion of Water Quality - {y D 13— iG -dLx
Facility NumSEEM - ®Division of Soil and Water Conservation
fl Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
[lesson for Visit: 0 Routine 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /Y/ Arrival Time: ,'3p Departure Time: P-0 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ®u.Jrr IIII Phone:
Onsite Representative: Integrator: bT�r v✓
Certified Operator: Awlf -e rv,Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream lmoacts
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. 1s 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 Pa No ❑ NA ❑ NE
[—]Yes ❑ No
[::]Yes [] No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued
Design
Current Design Current
Design Current
Swine
Capacity
Pop. Wet P0Wtry Capacity P p _
Cattle Capacity Pop.
an to Finish
to Feeder
W
Q�
La eran
Non -La er
Dai Calf
der to Finish
Dai Heifer
Farrow to Wean
Design Cyrirentr
D Cow
Farrow to Feeder
D .1P,ouI ..a aci P,n"": ;: ' r
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmoacts
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. 1s 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 Pa No ❑ NA ❑ NE
[—]Yes ❑ No
[::]Yes [] No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: -90Date of inspection:
❑ Yes
[!� No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[allo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
® No
Identifier:
❑ NE
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[g.No
Observed Freeboard (in): 5 it
❑ NE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
0 No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
[:]NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
T f o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[::]Yes
R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [A No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): _ ` j6llyN�st lDtrcrSr �50� _
13. Soil Type(s): (j / 'gV0 It ed
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MA No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []R 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
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q 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
[g.No
❑ NA
❑ NE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�j No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: - Date of Inspection: 3 /�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
C-] Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [? No
❑ Yes ® No
❑ Yes E3 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question.#).Explain any YES answers and/or any additional recommendations or any=other comments 4Tom. �
Use drawings of faciliiy;to better explain situations (use additional pages as necessary). Ce '
G -j 0 -P)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g70-�3'��3oD
Date: 3 13— /3
2/4/2011

(Type of Visit: OToce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
(�'R I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; o Departure Time: S p County:
Farm Name: %G�✓; ►t /1�,ry J� Owner Email:
Owner Name:mrJ9,�5 /y,,%y�t rV Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: d5 �i �^- Title: Phone:
Onsite Representative: J/'W'071"ar _ hr✓ Integrator: /1 'O_�
Certified Operator: �0�l!✓� '' _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [� No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
aPrige I of 3 L 2/4/2011 Continued

lFacMty Number: - p Date of Inspection:/�—
Waste Collection & Treatment
i- 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ID 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?
(i.e., large trees, severe erosion, seepage, etc.)
[:]Yes ILS No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
❑ 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
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E -No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[allo
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Faiiure 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): C
j2y,k,
13. Soil Type(s): p�,y� /r✓�S�it"`�/ S%/�µ �s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ELNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Eg No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U] No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: -- " 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
1�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes B No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes jr=--Ij 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes 53 - No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comment&(refer to question #): Explain any YES answers and/or any -additional recommendations,or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit O'Gompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 01 outine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : �0 Departure Time: % 0 s1v County: 2414— Region��
Farm Name: t�/%d�; ►ti- Nil rS f,: K Owner Email:
Owner Name: �h Q»7�rsrDi /%j—/I/% �+-- Phone:
Mailing Address:
Physical Address:
Facility Contact: At tl n ol.'t Title: �l� C` Phone No:
Onsite Representative: Integrator:
Certified Operator: 1+71 Operator Certification Number: 16 Z�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=g =46 Longitude: = o =' = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Current "
DesigH*
Design Current
Design Current
Swine
city Popul hon 7'Wet�Pouttry
Capacity PopulationC ttte
Capacity Population
❑Wean to Finish
-
❑�La er
..
❑Dai Cow
❑ Yes
Wean to Feeder
M2dNIE] Non -Layer
❑ Daia Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Feeder to Finish
❑ No
❑ Daia Heifer
❑ NE
❑ Farrow to Wean
Poultry,
❑ D Cow
❑ Farrow to Feeder
spry
"' -
❑ Non -Dai
❑ No
❑ Farrow to Finish
e ❑ Layers
❑ Beef Stocker
❑ Yes
❑ Gilts ME] ❑ Non -Layers
❑ Beef Feeder
❑ NE
El Boars
"- El Pullets
❑ Beef Brood Co
❑ NA
❑ NE
rn ❑ Turkeys
r.
Other
El Other
_. ❑ Turkey Poults
El Other
NiJmber,of Structures:
12/28/04
Continued
ii
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
S 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
29 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
$9 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facifity Number: 9 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA EINE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): 3�}
No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
O No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
Eallo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
KNo [INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
C.No ❑ NA ❑ NE
maintenance or improvement?
Waste Applicadon
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[9 No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
iA No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a/ n &lr r��SB'7�Or�
13. Soil type(s) J&ey -r.0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
❑ NE
Comments (refer to question .): Explain any YES answers and. r any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name00Phone: 33x.77
Reviewer/Inspector Signature: - Date:
Page 2 of 3 12128104 Gontinued

I Facility Number: —Z221Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo [:INA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes L&No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a 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
$6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ 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
RNo
❑ NA
❑ NE
Other issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TLNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(a 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
Jallo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
A`ddrhoaal1Comn s andlxor.D�w!ngs--
CD �IVJ
i
Inv
Page 3 of 3 12/28/04

El
Type of Visit ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ; / County: 2jA01- ^-- Region:
Farm Name: _fie /r/' i ✓L, hi a S>°rY ~�`3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: vA� Title: i2Wn r/— Phone No:
Onsite Representative: '40 "no'- - T .n n r0-- Integrator:/*" V rte/
Certified Operator: a-!$ Operator Certification Number: 37
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =4 = Longitude: =0=6
n=6 = N
Design Current
Design Current
Design Gnrrent
El NE
❑ Yes
Swiae Capacity .Paapulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
I
❑ Dairy Cow
❑ Dairy Calf
❑ NE
Wean to Feeder (v1D 61 IE] Non -Layer
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Outer
❑ Other
❑ Turkey Poults
❑ I
Dumber Structures:
Other
of
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CANo ❑ NA ❑ NE
❑Yes
[I No
E] NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®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): :2L50
Observed Freeboard (in): 432
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 29 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 CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% 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)
a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ULNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
2, No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
G.No
❑ NA
❑ NE
gComme�tts refer to+
y� P • �!ges=Iffiequssa
yrments.
g ;ty1 p r ( P ry)ns or an otquestion` Ex lain anv YES answers and/or anUse drawtn sof fac�h to better ex lain situations. use additional alk.
Reviewer/Inspector Name
Reviewer/Inspector Signature: `
Phone:
Date: 7_11V _1�20/PJ
2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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 [RNo ❑ 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
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5INo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[8 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
iS 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
�0dtt, nal &; qtsand/or Drawings
L
Ige 3 of 3 12/28/04

r
Type of Visit 1;166mpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine O complaint O Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: [� Departure Time: ? (� County: 4 4�- Region:
Farm Name:.�/%%�//� ►'L f I, y'` ��+ 3 Owner Email:
T"
Owner Name: Zx&v",& 5 � &, +ti. Phone:
Mailing Address:
Physical Address:
Facility Contact: H-- Title: r Phone No:
Onsite Representative: _:�Lo a&n ftaZ�Q�l1 Integrator: MIJ/ "
�M2fes
Certified Operator: � W_ Af�f �-Y- - Operator Certification Number: --
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O = 0 Longitude: =0=' ❑ u
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish I
Layer
❑ Dairy Cow
Wean to Feeder OrD I
ILI Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
a. Was the conveyance man-made?
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
El Non -Dai
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ No
❑ Turkeys
❑ NE
Outer
❑ Turkey Poults
X No
❑ Other
❑ Other
Number of Structures:
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q? -No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

' Facili Number:
t tY — � Date of Inspection i.lL�J
❑ Yes
❑ No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P -No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ Yes
❑ No
❑ NA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
XNo
❑ 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
R No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
S�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
��//
Gd No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that nevi
❑Yes
} No
❑ NA ❑ NE
matutenance!impWvement?
11. is time evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
29.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
'Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerMspector Name Phone:
Reviewer/luspector Signature: Date:
12,28/04
Continued

Facility lumber: — bate of Inspection
r
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [❑ Yes CKNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ap El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo ❑ 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
04No
❑ 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
JKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;9Vo
❑ 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
0.10
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewertinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I&No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

i
Division of Water Quality
Facility Number r �--- 0 Division of Soil and Nater Conservation
Q Other Agency
Type of Visitom��piiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0.900utine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: FT~ O- Arrival Time:F7 ; -5 ID I Departure Time: County: .-11_ Region:
Farm Name: /n CV + ''L- u r Owner Email:
Owner Name:. _ali Cwn a.S � t Phone:
Mailing Address:
Physical Address:
Facility Contact: __FAT>eAas _M -#P L V Title: Phone No:
Onsite Representative: —_ S'_� integrator: 11�ffx 49
Certified Operator: Operator Certifica on Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =1 e =I = 0 Longitude: = ° u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
U-1 Wean to Finish ❑ Layer
❑ Wean to Feeder o0 Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Discharp_es & 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 Populatiao:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: -
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
DkNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: r} Date of Inspection
'
Soil type(s) &11�
AL
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a No
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19 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:
Does the facility lack adequate acreage for land application?
❑ Yes
[8 No
❑ NA
Spillway?:
Designed Freeboard (in):
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in): ? _
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Callo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
N No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9 -No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes JONo ❑ NA CINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EgNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C j r A I WA -J-1
13.
Soil type(s) &11�
AL
Reviewer/Inspector Name ----Y� Phone: 3,3 7 3 00
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
0No
❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
JN No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[8 No
❑ NA
❑ NE
1$.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
x.4rR�9"r �. -.. ..
.Comments (refer to question ft Explain any YES,answers andlor any recommendations 0 an_ other comments �w
Use drawings of facility to better explain situations. (use,addittonal pages as necessary):
AL
Reviewer/Inspector Name ----Y� Phone: 3,3 7 3 00
Reviewer/Inspector Signature: Date: QZA2007
Page 2 of 3 112/28/04 Continued

Facility Number: — 9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 9 N [INA ❑ NE
the appropirate box. ❑ WIJp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3(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 XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EL No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CjjNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(,�gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
H 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
19 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
E9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
[INA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit (r'j',,ircomn�pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit rdrioutine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: .+�0 Departure Time: QCounty: Region: L D_
Farm Name: &fZ—_Z-n 1416t e Owner Email:
Owner Name: r �� �?�/! (/i _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Z_e�wa2.,�t �,�Zzzi I k1l Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =6 =" Longitude: 0 ° ❑ ' = "
Design Current
Swine CapacityM Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ La er
Design Current
Cattle Capacity PopuI tion
❑ Dairy Cow
❑ NE
❑ Wean to Feeder JCW&OD WLf❑Non-La
er
❑ NA
❑ NE
❑ Dairy Calf
❑ Feeder to Finish
"" `k
❑ Dairy Heifer
❑ Farrow to Wean
Dry Potiltry*'r
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes R No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
12/2$/04 Continued

Facility Number: 91— Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
1
e
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): L7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
through a waste management or closure plan?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes allo ❑ NA ❑ NE
❑ Yes JK 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 9 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 f $.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10- Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JB ­No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 1Q% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable
�Crop Window [:]Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) eVepy pWZ 2ff::t1s lt%izv �GXnWr e
13. Soil type(s)&_z
14.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 10 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes JN No ❑ NA EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ®.No ❑ NA ❑ NE
-Comments (refer to question ft Explain any YESsanswefs and/or any recommendatigps�nr�any-other amments
-Use drawings of facility to better explain situations x{use addibanid pages as necessary)
Reviewer/inspector Name Phone: D— �S �p
Reviewerllnspector Signature: Date: _ !?�� O
Page 2 of 3 12/28/04 Continued

Facility Number: Of — Date of Inspection
Required Records & Documents
1� I9. 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 9No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design L1 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 29 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
On No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fZ 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
P9 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
;KNo
❑ NA
❑ NE
Additional Comments an
dlor Drawings: x, ,
...._ ._
Page 3 of 3 12/28/04

Type of Visit (0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Ij-QZ-DS Arrival Time: t7g; Z,S` Departure Time: County: Region:
_
Farm Name: _ e- 1 of /Y d at^SGY, 1,-,3 Owner Email:
Owner Name•%—�n�r� �%Ilii✓ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: I<e.U1'N__ R61Q1'n1_SQA1 Integrator: Ayp;,04
Certified Operator: aS S, 1Ffe,1CI n1 _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =6 =., Longitude: =0=4
°04 0 0i
Swine
Design Current
Capacity Population
Wet Panitry
om
Design Current '; Design Current
Capacity Populatioa ; .Cattle Capacity Papuiafiou
❑ NE
❑ Wean to Finish
❑ La er
a
❑ Dairy Cow
Wean to Feeder
2600 Z100&
❑Non -La et
❑ Dairy Calf
❑ Feeder to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ Dairy Heifej
a
El Farrow to Wean
❑ NE
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
"" Non -Dairy
❑ Farrow to Finish
® No
❑ La erg
❑ Beef Stocket
❑ Gilts
❑ Yes
on -Layers
❑ Beef Feeder
❑ Boars
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Pullets
❑ Beef Brood Co
❑ NA
� . -
❑ Turkeys
!,
He
❑ Other
0 Turkey Poults
❑ Other
;" Number of Structures:
11/28104
Continued
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 past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
11/28104
Continued

Facility Number: 0 Date of Inspection
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IM 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
[❑ Yes
[9 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
Dd 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 ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El 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) CktejSO n!
13_ Soil type(s) 5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
2-3—
Z5' R .; N b eV s
141
;F 7, 1/ -54' ��UKte-5�4�c
� e�p—Fi

Facility Number: 047 —190 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box. ❑ WCP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ 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
99 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of thepermitor 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Co'mmeatsaiid/oe Drawings:
a;
12/28/04

Facilitv Number.
// Z10 5—
a19—
—D19— 190 Date / ol/ , z , zoos'
Farm Name _Z7�
C.O.C. AiJ509p190 permed A16lemaa-D
on hand
d gly/�'r
Waste plan ✓ Soil Test PLAT Deep Soil test
Soil type
Crop types
J
Designed Freeboard
Rain gauge Rain breakers
Calibration of spray equipment
Sludge Survey - Crop Yield
Observed Freeboard
Daily Rainfall
G.P.M.
120 minute inspections
1 in. rain inspections Weather code ✓ Weekly Freeboard
Waste Transfersj�l f Waste Analysis
Pumping time
Waste Analysis % & Month
Comments:

wn DDSWC,Animal,F_eedlot Operation;RiAfew {.
,a- m; �. ; �;. x u `t2 " � ^�; ?� ;,�. moi" .s+ 'tw �` �- �` �.. °b`�-.,c�.�''@�pg. `'S ��.•, 'c°°a' - Y i� ,",�i� � -_ � ..
ys. x, �-�z z3,. _L
x� _ ®DWQ Animai Feedlot Operation Sle Inspection��
„' # b
k
� u ,t 'xk� "xw'�w<.,r. -:s:;� k ,-:i�'ea vEn't`..a '^`x ,�, "'x.x•,x �._ a,�.
0 Routine O Complaint O Follow-up of DW2 inspection Q Follow-up of DSWC review O Other
Date of Inspection
Facility Number j}
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 0
❑ Certined ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: v��.�, y�...._. ...... .. .. County:. _ALJ,¢��✓ �. , _
Land Owner Name: o..� .� �v�s� .._ .... _.. — Phone No:
Facility Conctact: 10
Title: _.. .., _ ._ .. .._ Phone No:....�
Mailing Address:......! zAb .,� .1�7 'oeo.� �� ! 0c, 7" Y/ .............._.......
Onsite Representative: —4zAil. _ ,5 .... _ .... _ Integrator:L'
--7 .. .=.� ..
Certified Operator:... f.C.� � .... ._....... Operator Certification Number. / /�
Location of Farm:
Latitude �• �< u Longitude • 4 0 K
Type of Operation and Design Capacity
--i **:,�rsaaa r d.a�^"r �.,=,, y,. �r:.
#$ivr eDesign Crrent �. Design Current C lexsDesignCurrent
� . h":.Ca act Po ulaaon `.>< .. a act PoF ulahon ,.mow _ � _� Ca act �Pa ulidon''
®Wean to Feeder !ib =, Layer �r ❑ D
❑ Feeder to Finish , ❑ Non -Laver x ❑ Non Dairy
�. 0 Farrow to Wean �f�
Farrow to Feeder {�
r Design Capaci€y �,_
Farrow CO Finish x -W,.
❑ ocher _.� Total S�S
Y.
i s �ak� r
Number of L. oons�/Holdin Ponds
A age Y g ❑ Subsurface Drains Present
� �,� � "�' �� `7 ❑Lagoon Area ❑Spray Field Area "�`��
Genera
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30197 maintenance/improvement?
❑ Yes No
❑ Yes )qNo
❑ Yes V No
❑ Yes [KNo
❑ Yes "KI No
❑ Yes No
❑ Yes XNo
❑ Yes XNo
Continued on back

- Fnc84ty Number:..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)<No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
,NNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
ATNo
Structures fl,agoons and/or Holding Po_nAsj
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
R Na
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.._.s'/ .. . _ . _.. ............ ...._ _ . -... _ �.
.. _..
-......._
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
ArYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
XNo
Waste AWiration
14. Is there physical evidence of over application?
❑ Yes
,T No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typerc!�. .. �_..—_.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
j$No
18. Does the receiving crop need improvement?
❑ Yes
j'No
19. Is'there a lack of available waste application equipment?
❑ Yes
Ix No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
No
For Certified Facilities1
22. Does the facility fail to have a copy of the Animal Waste Management Pian readily available?
❑ Yes
�No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
kNo
24. Does record keeping need improvement?
❑ Yes
)ONO
Comments y(refer ta'giieshon"{#} Exp lairi'aay YES'answers and/or any recomumeiadations or any other commentary
Use drawutgs:of facility to better explain situations (use additlonal:pages "is necesiary)
��nO,E �i.✓iE� /�� /� CO ��EiC J�•�r�'9V!/� /1 pU �j� G✓�
d.P.�Ls-�
Reviewer/Inspector Name ; w gg
Reviewer/InspectorSignature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97