260003_INSPECTIONS_20171231

(N k VA -5 9 3 k.A1.1 , 1Y bQ
Type of Visit: p Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Nrrival Time: z, so � Departure Time: r ;5 County: aA-&��/4?�Region:
Farm Name: ! y �'wV �`t-� Owner Email:
Owner Name: tel` �f `'`1 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: LC�
Certified Operator:
Sack -up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number: 376
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
r_Q N6
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
DesignCurrent
Design Current
Swine
@opacity Pap,
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ No
Layer
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Wean to Feeder
Non -Layer
I I
❑ Yes
Dairy Calf
Feeder to Finish
V
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 -No
Dairy Heifer
Farrow to Wean
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Design
Current
Dry Cow
Farrow to Feeder
Dr. Pouitr.
Ca aci
Iio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
OtherI
irkeyPoults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
E] Yes
r_Q N6
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ <A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[J- I�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[r} A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
% No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Y,,t - 0 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q19o-0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NoNE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (c�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ 4o' ❑ 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
(Er<o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
o
❑ 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?esTo
❑ NA
[:]NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
E] Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3"No
❑ NA
❑ NE
maintenance or improvement?
[]31�o
r] NA
❑ NE
Required Records & Documents
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fNo
❑ NA
❑ NE
maintenance or improvement?
[]r�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:r`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 Barc Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,''� �r`� t& -Cc 6�(ult. 4,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F_/Wo
L -6 -
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3'<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]31�o
r] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]r�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�To
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2,Ko
❑ 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 [�rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: G. Date of Inspection: 4.3' �s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D -Afar- ❑ NA ❑ NE
-25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-'fq6`__❑ 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 E] -<o ❑ 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 ❑%tom ❑ 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
Quo
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
El"No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ff No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[D—No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[!rNo
❑NA ❑NE
[] NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any, YES answers'i i d/oi- any additional,.recommendutions or,any other comments
Use drawings of fne'llity to better ex ' lain:situations.(use;additioiial.ages:as necessar ): ;... .' .
rAt\141 9_01
s", -mss' '-
v
—7 ua Itil s i e� e°, 0 �,.�� u o+� L,4_((5,
PE Is �" I % S I A, C 0 U e -k"% 0 1'-%- 1 C-) 1� , , k —Pz (P ,
CJS 910--3of-kP
Reviewer/Inspector Name: 61t.
`1 D t"UL Gtr Phone: la 33_-7y'
��/
Reviewer/Inspector Signature: � Date: � 1
Page 3 of 3 21412015

l ti1n S_ f 40&l L- f
PPIDivision of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (24outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ✓ Arrival Time: Departure Time: mnCounty:
Farm Name: Owner Email:
Owner Name: a,r✓�/ �/- Sly Phone:
Mailing Address:
Physical Address:
Facility Contact: 1S4tvk jtZA' Title:
Onsite Representative: I
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 'E yn i ..0
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish �d Y
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Non -L
Pullets
Other
Poults
Design Current
Discharses 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Region
Design Current
Capacity Pop.
❑ Yes g-lqo— [] NA F] NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes No
[] Yes No
❑ NE
[]NA [3 NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 121412015 Continued

Facility Number: 7L - Date of fns ection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ie— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 -KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/] No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[3<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�Io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes [] N ❑ 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 J,❑ Application Outside of Approved Area
12. Crop Type(s): 0 �� co +tel l ci{teeq
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
[/] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes F—,Ko ❑ 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] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: b Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R?Ko_ ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q•I'd —[3 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 FA -ICP ❑ 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 mortal ity 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 Reviewerllnspector fail to discuss review/inspection with an on-site representative?
34. Does the I'acility require a follow-up visit by the same agency?
[:]Yes ©' ]leo ❑ NA ❑ NE
❑ Yes [3< ❑ NA ❑ NE
[:]Yes 2<o ❑ NA ❑ NE
❑ Yes ❑176 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes g90Yes
❑ NA ❑ NE
DNA ❑NE
❑NA ❑NE
Comments (refer to question #): Use drawings of facility to better explain situations (use additional agesastnecesSlain any YES:answers and/orany ca} mendatiung ar anyothercommen
,
C.4,I; C r444 Lei"
� g �
Reviewerllnspector Name:
Rev iewerllnspector Signatui
Page 3.of 3
Phone'(�y�`_���
Date:
2/4/2015

�, ivision of Water Quality
Facility Number 1..� - ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: B -Com fiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:,"* Region: FOCZ3
Farm Name: a P C"5iv f'" -e
Owner Name: f_(' ' 44"i d eater
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: C 041 , f Title: Phone:
Onsite Representative: Integrator: —Pe,
Certified Operator: R .Lt�'z f +h, Certification Number: '�' 637 a
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes 10 ❑ 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 eNo
Q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fl4.N� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes g] Ko' ❑ 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
©'o
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
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?
ElZfe's
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ff;o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[BITo
[DNA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'1�10
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [?'No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a SGV
13. Soil Type(s): tti,
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes �?do ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [--N—o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑010 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes a<)
❑ Yes FZ No
❑NA ❑NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes14
❑ 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesTo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [yNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: U. jDatc of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 3-M ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes .217b ❑ NA ❑ NE
❑ Yes [3'lVo ❑ NA ❑ NE
[:]Yes ENo ❑ NA ❑ NE
❑ Yes [Ero ❑ NA ❑ NE
❑ Yes [ J//No ❑ NA ❑ NE
❑ Yes 6c, ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Eno ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑'fslo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes eNo ❑ NA ❑ NE
Comments (refer to question#): Explain,any YES answers and/or any additional recommendations or any„other comments.
Use drawings of facility to better explain situations (use additional pages as:necessary).
GL4e__ t �=
t e Imo.
C
o 5; 4A &--3�-
r��l t
0. �-, r 17- 3. S
Reviewer/inspector Name: l
Reviewer/inspector Signature:
Page 3 of 3
p--� 1, 0 0 •ti
i c u %&A
Phone: 11-\J- 71
Date: ' l� l
2/4/2014

. t,310S-7 r�� C 1-�3 4
vlsion of Water Resources
r Facility Number ` - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit:Zoutine
lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L VI'Lival Time: Departure Time: County"6144']Region
Farm Name: _rN Owner Email:
Owner Name 1 to ✓1 Phone:
Mailing Address:
Physical Address:
Facility Contact: C4ea._'" /� i/4�/l�l/ Title: Phone:
Onsite Representative: l 1 Integrator:
Certified Operator: VN Certification Number: d 3 Z
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Degign Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish —17f1A�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Nan -La er
Pullets
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Design Current
Capacity Pop.
❑ Yes ©'fio ❑ NA ❑ NE
,a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b:`_�:Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑No
3-1 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
QXo
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ErNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2014 Conth

Facili Number: 16 -_:,:V60 Date of Inspection:
U
05o
❑ 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
,-��
Lam' �u ❑�NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ Yes
10
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ld"'o
Designed Freeboard (in):
❑ NE
Required Records & Documents
?
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
42-!To� ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
% No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2�'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?
2-1�es
❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-<o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EgNb ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
05o
❑ 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
�io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ld"'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eT
❑ 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 El Checklists [3 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ZNo ❑ 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 2/4/2014 Continued

Facilit Number: - Date of Inspection -
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[5 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
S: 15
❑ 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
io
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[f*No
❑ NA ❑ NE
Other Issues ��
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1"o ❑ 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 10 ❑ 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 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 [DI�o ❑ 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 Q'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑/ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary):
cu(t
T°P li� o ue-iA,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
U Phone: 7"l is
Date:.
21412014

� -I"s Z/11 /Is -
OHM
rsv cion of Water Resources
Facility Number �.J - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 04routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ` Departure Time: ' Qa County �"'W
Farm Name: G c.SGll P'L'C Owner Email:
Owner Name: 6CA q 14 o-1 Phone:
0
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
G(
d"4 -Title:
Certified Operator: �•�•f'�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Region:F—F—*0
Integrator: Ale114 - 2
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
lets
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [gW_❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
[:]Yes
❑No
[:]Yes
�o
❑ Yes
10
P -NA ❑ NE
]A ❑ NE
2-5-A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/412014 Continued

Facoity Number: jDate of Ins ection:
,
Waste Collection & Treatment
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F'1Qo
r4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[C -Nb --F] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No [moi
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
[]Other:
Spillway?:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
Designed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in):
❑ NA
❑ NE
❑ Rainfall [3 Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q'tao ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
I Yl"O ❑ 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?
gj�es
Q No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2 -Go ❑ 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
�o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F4'Kb__ ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2110 ❑ 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
+ Wiin/dow E] Evidence of Wind Drift [] Application Outside of Approved Area
l �T7ti
12. Crop Type(s): v�_ #_ 13u`Wt"A S6 0
13. Soil Type(s): —- A44'-
,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F'1Qo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F714o
❑ NA
❑ NE
acres determination?
[]Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
X10
❑ NA
❑ NE
Required Records & Documents
,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D Ko
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box belo
F-1Yil
Yes
❑ No
❑ NA
❑ NE
WasteApplication ❑ eekly Freeboard ❑ Waste Analysis Analysis
Crop
E] Waste Transfers
❑ Weather
Code
❑ Rainfall [3 Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
G? No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Fac! 't Number: - Date of Inspection:
)4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Bio
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [IQo
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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Er'N'o
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 tilt 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? ❑ Yes [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑'Ko' ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [D4o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations;(use°additional pages as necessary).
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes L?<o ❑ NA ❑ NE
❑ Yes �lo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes U2110 ❑ NA ❑ NE
'-7
J
�c
`6.1 t��
0,7 0
�s td, 41 0
� a( erg 114 , sol 4n4ysCs
•Reviewer/Inspector Name: + L Phone:
Reviewer/Inspector Signature: Date: 11 Fh IS
Page 3 of 3 2/4/2014

01M3 -Pf gh3jj3
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Q Corm Hance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: o tine (2; Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
S
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: R q. C, g Owner Email:
Owner Name: Rl I chacaC.. Emej, Phone:
Mailing Address-
Physical
ddress:
Ph sical Address:
y 5-7bo_ Pftry
Facility Contact: F A Title: _ �r/�1e(� Phone:
Onsite Representative: Integrator: pfetfaa e -
Certified Operator: Way eOJ03 Certification Number: o7Q'37�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Non -L.
Pullets
Other
Design Current
Discharges and „Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
e
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy L
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [—]No
❑ Yes [:]No
❑ Yes ® No
❑ Yes Eff No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number; - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
C' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift la Application
Outside of Approved
Area
12. Crop TYpe(s) Be/
' Wv & !
13. Soil Type(s): P y' '
14. Do the receiving crops iffer from those designated in the CAWMP?
[3 Yes
0;�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
12] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes]
Na
❑ 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 ED No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ®'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
U NA ❑ NE
Page 2 of 3 214/2011 Continued

Faeili Number: - r�
� [t7V� Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O:No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ❑ No RNA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
C3No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): 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).
�1 �rodow had' bees Ta7ll ca�, I ea,�(, f � undo a`�`fln�dary w al�-�. � tan, TOW r4 ef.�a,If
flay, has-dna wn I to 10cl ude CL 1�r Cro ( whec�} an�Occl�a/e.
1 The. Il ha0
Oreas aroillid. Yve l is In)ddl e cr,o� ale edge se e d I
�
�2.4��ro td .ly frojromm6LrA
.Pt�ut& says hf-hafavo�drJ' sf-rali new WP.! 1.5;
SiDtl% harwher-A cb-scdfrdbr ! M r W -a4. by �rddC �6iho llowes
d i v�tJi4� in p Ore or ma p al /�1'
ds.
?1 cal vedj PW ,.,& 1v11I CEDL -o Ichen,rCa 1 nftm X11 f a
�) Grag o,l I ajon 0*54e honk, habee,,, paf -j !f l Ind b 53Aridde
Ms f ca-riti �odu et�I+ har worked S 4 f i `� �b�� �, c� s ��rOvPotbUrt- w{1 �mfxe. �vvlk,
M�1 is be1� � lar.�.o� bpi 1d ids ,
Yves l mgl�i��e�,
9
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3`404 SAneLL Phone:
Date:
2/4/2011

. Facility No'. ' Farrmm Name C 1-f)74? Date Aaa-(.B
Permit i' COC ✓ OIC NPDES (Rain breaker PLAT
Annual Cert Daily Pipe)
Lagoon Name; S for s illwa 1 2. 3 4 5 6 7
Design Freeboard.) Last' Recorded in
Observed freeboardAL
Slud a Surve Date: 1
Sludge Depth' ft
Liquid Trt.
Ratio Sludge to Treatment Voldme ifs 0.45
Date out of com lience/ POA?
Kim. H
..
Verify PHONEINUMBE kS;and affiliations
Date last WUP FRO; ;���,�
Ef
Date last WUP at farms
MIX01 4 9 r. LO--�---
i ;
App. Hardware i f: ',fit i.
. - .-®-----�
Stop Pump
• i.!,l
Sofes�' Ne!!L" Crop Yield Transfer Sheets `
pH Fieids Wettable Acres , , RAIN GAUGE
Lime Needed:i WUP Dead box or incinerator
Lime Applied; Weekly Freeboard ✓ Mortality Records ✓
Cu -1 Zn -I 1 in Inspections +X- Check Lists
Needs S (S-1-525): ` ; 120 min Insp. ✓ Storm Water
IVppds P i : WQathpr rnrlpg i
RVATEMUS 2M 1=11 arm
IIIIIIIIIIIINI
..
..
Verify PHONEINUMBE kS;and affiliations
Date last WUP FRO; ;���,�
Ef
Date last WUP at farms
Lagoon #
i ;
App. Hardware i f: ',fit i.
Top Dike SpS
Stop Pump
• i.!,l
Start Pump �qcf
Conversion-.-Cu-I, 3000=1108, Iblac; Zn -I
3000 213 lb/ac
Verify PHONEINUMBE kS;and affiliations
Date last WUP FRO; ;���,�
FRO or Farm Records
Date last WUP at farms
Lagoon #
i ;
App. Hardware i f: ',fit i.
Top Dike SpS
Stop Pump
• i.!,l
Start Pump �qcf
Conversion-.-Cu-I, 3000=1108, Iblac; Zn -I
3000 213 lb/ac

i.
U Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit:Com Hance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: O7Routine O Complaint O Follow -un O Referral O Emereencv O Other O Denied Access
Date of Visit: UArrival Time: Departure Time: A County: G I mbtLtg,6D Region: FRo
Farm Name: P—
Owner Name: ���� E q -50f')
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: y=cjnNR Title: OWAT Phone:
Onsite Representative: r;aqM Integrator:
Certified Operator: U:Ng+R� SvN500 Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
llry Poultry
Layers�
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes � No [:]NA [D NE
[:]Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
[:]Yes No
❑ Yes No
NA ❑ NE
�NA ❑NE
l9 NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

i
Facility Number: aid - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E4 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes]
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
6� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5Q 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
C4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): '�&R Mn'M b Atk!i� S. r'x( .01'46)
13. Soil Typc(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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes { No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes] No
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

4 i
Facili Number: Q10 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lt11 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E4 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
It 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
CZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
OQ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[A No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: LAI
Page 3 of 3 2/4/20114

Q
I�'aciiify Num6er(o Q ®"D'tv,�sian of Soil and Water Canservatian
� Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L/ — Arrival Time: D ; 00 Departure Time: l V County: C%1 ,�„` Region:
Farm Name: ,5 k/.f ki Y Owner Email:
Owner Name: ( ;fir et -o( rwA If— Phone:
Mailing Address:
Physical Address:
Facility Contact: _;Z, 'l,, j — D Title: Phone:
Onsite Representative: mal&x 0— Integrator:
01
Certified Operator: _CA0,I-,-,<— Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
�
Design
Current
Design Current
Swine Capacity .Pop
Wet `Poultry '
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Nan -La er
Dai Calf
ceder to Finish
Dai Heifer
Farrow to Wean
Design
@urgent
D Cow
Farrow to Feeder
pr, Poultr..
Ca aci
Po ,
Nan -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other11 �
urkey Poults
MOther
Other
Discharees 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
[:]Yes [a No
[:]Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -C) JDate of Inspection:
❑ Yes
[S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
[DNA
❑ 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?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 -Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Anmlication
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 [KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cl a A9 vie --.5r r _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5Q 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
[S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
[:]NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ 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 El No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ec No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

�l
Facilit Number: - Date of Inspection: 1
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
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
unj
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 EQ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes J�] No ❑ NA ❑ NE
[:]Yes [j 'No [DNA ❑ NE
❑ Yes [;� No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[DNA ❑ NE
[DNA ❑ NE
Comments (refer to question ##): Explain any VES answers and/or any additional recommendations'or any other comments
Use -drawings of facility to better ex lain situations (use additional R ages as mecessa ). q t _ , a... < > � .1;� t r ,
{9 �vriiS 7 0 '9
f -re 0r -4s 7� �f_ X -111W
Y
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
me
Phone: Lo iJ3-3-�0o
Date:
21412011

tj.
ivision of Water Quality S Z__^1
Facility Number 0 Division of Soil and Water Conservation G y3�Ji�
M jZ U 0 Other Agency
Type of Visit �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: li D Arrival Time: 0 C� I Departure Time: r O County: GLsyi. cock n- Region:� '�( 0
Farm Name: �' G � l -y r n -r Owner Email:
Owner Name: ���' ��r. 4—�c_syr Phone:
Mailing Address:
Physical Address:
Facility Contact: Z���ddo� ��.s p- --Title: Phone No:
Onsite Representative: `S Integrator: ,
Certified Operator: !� T'�Q.St7"�J Operator Certification Number: 4&2 ?a
Back-up Operator:
Back-up Certitication.Number:
Location of Farm: Latitude: = e ❑ I ❑ 11
Longitude: =0=1 = 11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er�--
Other
❑ Other — --�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
10 urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ DEX Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: dJ
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 M.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes 29--N;o ❑ NA ❑ NE
Page 1 of 3 12/28/04 Continued

• Facility Number: (o—D3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes J.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes gNo ❑ NA ❑ NE
❑ Yes 0,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 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 ZINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 29 No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ 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 CAWMP? ❑ Yes . allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 14 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Z[No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 1KNo ❑ NA ❑ NE
Comments refer to" destion # Explain an YES answers and/or an rec r ffie dations or any other cpommenyts � `,. 4
Use°drawings of facility to better explain situations. (usc°additional pages as�necessary); *$s,N 4U;ei WI,4,
(/
Reviewer/Inspector Name i '.i t "�" Phone, �b~ y.33-33�
l.r r
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number:,2b b — 03 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f � No [INA ❑ 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
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes.
QNo
❑ 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
Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[-No
❑ NA
❑ NE
Additio,�
na� ,�AW
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0,1 utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��� Departure Time: County:
Farm Name: d -G �5 &/;" Owner Email:
Owner Name: i EhlyF4 JF5/IJ <fJ7_" Phone:
Mailing Address:
Physical Address: /
Facility Contract: _ MG dD�Title:
Onsite Representative: otit��
Certified Operator: rig �d• ay-�
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:�D
Latitude: =0
=6
Longitude: =0=6 0 `d
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
rrent
DesignE-t—
Design Current
DMan Current
Swine Capacity Population
Wet Pt►ul__ y Capacity Populatiog
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Dairy Calf
❑ NE
❑ Wean to Feeder
❑ Non -La er
Weeder to Finish
ANo
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Pry Cow
❑ Farrow to Feeder
[:1 NE
ElNon-Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
[IBeef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑Yes
®No
❑NA
[:1 NE
12/28/04 Continued

Facility Number: — Date of Inspection D
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
T Waste Collection & 'Treatment
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9.No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(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`?
M Yes
NTQo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(R No
[INA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
• r
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
KNo
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J.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/SIudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) yac ml an -0 e1/
13. Soil type(s) ALL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tgNo ❑ 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
CKNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9.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):
17;;Ft, 14 J!n_
0
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date: (�
12/28/04 Continued

r
}I Facility Number:0 — Date of Inspection —U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists
❑ Design F-1 Maps ❑Other
❑ Yes �&No ❑ NA ❑ NE
❑ Yes S No ❑ NA EINE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
1�No
❑ NA
❑ NE
❑ Yes
E.No
❑ NA
❑ NE
❑ Yes 0 -No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes E.No ❑ NA ❑ NE
❑ Yes ®No ❑ NA EINE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
AMdit W*116amments a_nd�lor Dr�aw�ings:
12128104
12128104

- - Divisinn of Water Quality
facility Number '� �p �_,3
110
ivision of Soil and Water C•nnservation
ther A ency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S l s l7B Arrival Time: D l Departure'Time.. 0: County: imra- Region: Reo
Farm Name:2
5
nF� G W1I'lle_ _. .. Owner Email: ,e
Owner Name: f` l'oC{ ay'O� ut f.^4 F�4q.$Gn Phone:
Mailing Address: d10
Physical Address:
Facility Contact: _lu�'R �GSDr? Title:
Onsite Representative:
Ir
Certified Operator: B10'7'9 ► e 'Faxon
Phone No. -
integrator: �resiQG�
Operator Certification Number: X0369
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 =4 = Longitude: [� o =1 =LA
Desil;n. Current1111111
Swine C►ap,y Population
❑ Wean to Finish
Design C+urrent
Wet Poultry Capacity Pppulation
❑ Layer
Design Current
Cattle C•Rpflcity Population
❑ Dairy Cow
❑ Wean to Feeder
JO Non -La er
Il
❑ Dairy Calf
Feeder to Finish 0 1 01
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
[7l,NA
El
Farrow to Finish
E] Layers
E]El
❑ Beef Stocker
Gilts
❑Non -La ersElPullets
❑ Beef Feeder
EOBoarsTLlrke
❑Beet BCOOd C4W
❑ S
❑ Yes
Other
❑ Turkey Poults
El NE
❑ Other
❑ Other
Number of 5truetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
rp No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
[7l,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
1P NA
++❑
El NE
2. Is there evidence of a past discharge from any part ofthe operation?
El Yes
[P No
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes�No
❑ NA
NI -
ElNE
other than from a discharge?
Page 1 of 3 1
12/28/04
Continued

. i.
Facility Number: — Date of Inspection 5 1 S
Waste Collection & Treatment j
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. Tf yes, is waste level into the structural freeboard? ElYes tNo , MNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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?
rp 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? ryes
❑ 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)
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
TNo
❑ NA ❑ NE
maintenance or improvement?
Use drawmas-of facility to better explain s►tpahons; (use AddWonal'pagesas`necessary}. q x
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tgNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rp No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
pJ.No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r,No
❑ NA ❑ NE
Comments (refer toquestion #) . Ezplain`any YES answers and/or any�recoinmendattons=or'any other comments
-
Use drawmas-of facility to better explain s►tpahons; (use AddWonal'pagesas`necessary}. q x
7, W St., 6a Owt?a OK .Gk s"I Oe
p I ba Phone:i�33
Reviewerllns ector Dame,
Reviewer/Inspector Signature: Date: SL/.!;LVB
Page 2 oj'3 12/28/04 Continued

y`
Facility Number; ab — Date of Inspection S S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C ,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 El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ed No ❑ NA ElNE
E:1Waste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil 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
t
[INA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
T�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�SNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 6 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ YesNo ❑ NA ElNE
and report the mortality rates that were higher than normal? IP
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZNo ❑ 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 V 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 4No ❑ NA ❑ NE
Page 3 of 3 12/18104

10 Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:3 Arrival Time: : ti Q Departure Time: 0 : 30 County: i"h Region: *5'Q0Farm Name: �jj _ S w �Owner Email:
Owner Name: gl%o Qlr BIiEX- IT �SOti _ Phone: tQ) IQ
eor 1 Z1
Mailing Address: 5760 Pee _-.20. qq
Physics! Address: ( l
Facility Contact: FZ4S O1'1- Title:
Onsite Representative: It
Certified Operator: �h�l -e _q_C'CL
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other.
Phone No:
Integrator:�e n
Operator Certification Number: :)_03t9
Back-up Certification Number:
Latitude: 00 0' =" Longitude: ❑e =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La eY
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf I
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes f?LNo ❑ NA ❑ NE
❑ Yes ❑ No FNA
❑ NE
❑ Yes ❑ No 1PNA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes [PNo ❑ NA
❑ NE
❑ Yes O No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: —3 Date of Inspection 3 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier'. 1
Spillway?:
Designed Freeboard (in):
asObserved Freeboard (in): 11
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes ❑ No ENA ❑ NE
Structure 5 Structure b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
b. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[] Yes
J� No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
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)
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
ENo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[] Yes
J� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: IU Qs7
Reviewer/inspector Signature: Date: .5 3
12/28/04 Continued

Facility Number: — 3 Date of Inspection (513ro�J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 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 ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
t
❑ Rainfall []Stocking ❑ Crop Yield ® 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 55 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
0 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
[�tNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C�lNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
91 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 Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
KI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-Farr`^
6111,C4bp'- ('ec"J ,A"S Placa tJkf). rnou?rg"o f'^
l\a,j OM46 n W l [ cnd uC.-� -� (o �..� -`� `"'� Nlr, E%0 07 .
W i it COM �•o Sc�e e-�olluw -tet
12/28/04

Type of Visit EMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /- a/o Arrival Time: a Departure Time: 11*1 County: C' *+" r Region: ! RD
Farm Name: C Owner Email:
Owner Name:. .R , GA a J e_a_s D _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 9;'e Ld -Fa . s nA_ Title:
Phone No:
Onsite Representative: _jig - e_ Integrator:7,ZZ,t:rj 7� �
Certified Operator: Operator Certification Number: "R031-9
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: o =1 Longitude: =0=4 o=4
Design Current Design Current
Capacity Population Wet Poultry C4pacity. Population
❑ Layer
I �I ❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 9No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
PkNo
❑ Yes
[LNo
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12/28/04 Continued

'j� . \;i
Facility Number• & — Q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Spillway?:
Designed Freeboard (in): 1 9
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ER No ❑ NA ❑ NE
❑ Yes LgNo ❑ 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 strictures need maintenance or improvement? E& Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?❑Yes rV No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ElNA [:1NE
maintenance/improvement? YW
11. Is there evidence of incorrect application? If yes, check the appropriate box below. MYes 9,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) 17G
❑ PAN " PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 0C_,13 �G' is /�o ►z 8S .
13. Soil type(s) u �.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
ER 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
(N No
❑ NA
❑ NE
aDu Y �D W nrJd r/04 l c n— �V A444l 0 B7' eu-l'5 4 rho r ffelY'V'am zi-006 .
Var �a�%, �7zr ,� r r�7-a oa7s 'U fit' era `n> 06 Be"~Ja, T// %.5, l� `je
!( � 8' !vi 7r ��I3rrtiradu
M-3 ove-r- 9 u 3$' /�s l 4 Dt/rr-
3 y o /o f to ib -4 Durr
Reviewer/inspector Name �" (o% f �w ( , �' i . Phone: /1D—
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: — 03 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 1 Yes ;SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N No [INA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. M Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 5Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the' ermit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
�4 No
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
[21No
❑ NA
❑ NE
❑ Yes
C.No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes EtNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
CqNo
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
A'dditional'Comments'and/or Drawings: !, :: � w . ya - x 1V'A * u K, � ` 4
r; r-✓-�-o�^`�-^�C
49
{ u6c C s7�►2'0� U�� W '�'I� PGw� i �� �r�r �.
12/28/04

Facility Number: � 3
Division of Environmental Management
Animal Feedlot Operatio--nsrrSite Visitation Record
Dater
Time: 2%30
General Information:
Farm Name: R 4- G County:
Owner Name: `��'c. .-� _ S�- Cr ys } j F(4$011 Phone No: 9LO —L -EV -1
On Site Representative: Integrator:
Mailing Address:
Physical Address/Location:__ U�A_ e
Vd �W lel _ ^
Latitude: I 1 Longitude: l 1
Operation Degeription: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
• Nursery 0 Non -Layer a Beef
Weeder a
OtherType of Livestock: Number of Animals:
Number of Lagoons:_ (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made Q Nor Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
(list the crops which need improvement)
Crop type:—�� 'ty rn- Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application? - -
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI -- January 17,1996
Yes ❑
Nola
Yes ❑
NOP
Yes ❑
Nd S
Yes ❑ No 21
Yes ❑ No Gb
Yes ❑ Nom
Yes U. - Nom
Yes` ❑ :. ;No M � : -
Yes ❑ Noir]
Yes ❑ No a

Maintenance
Does the facility maintenance need improvement? Yes ❑ NO(2C,
Is there evidence of past discharge from any part of the operation? Yes ❑ Nq�T
Does record keeping need improvement? Yes ❑ Nod
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No
Explain any Yes answers:
cc: Facility Assessment Unit
Drawings or Observations:
4
Date: 2 `7 4�
Use Attachments if Needed
AOI — January 17,1996